中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
8期
569-573
,共5页
孙筱璐%张健%王国干%庄晓峰
孫篠璐%張健%王國榦%莊曉峰
손소로%장건%왕국간%장효봉
心内膜炎%真菌病%病死率
心內膜炎%真菌病%病死率
심내막염%진균병%병사솔
Endocarditis%Mycoses%Mortality
目的 探讨真菌性感染性心内膜炎(FE)患者的临床特点、治疗方式和预后.方法 连续入选2003-2009年阜外心血管病医院符合Duke诊断标准的真菌性心内膜炎患者,对其临床特征、微生物学特点、并发症和死亡原因等进行回顾性分析.结果 共入选FE患者22例.中位年龄45岁,男女比例2.1∶1.13例(59.1％)患者为医疗相关性感染,1例静脉吸毒相关感染.最常受累的瓣膜是主动脉瓣(40.9％),其次是二尖瓣(13.6％).16例(72.7％)患者超声心动图发现赘生物,＞10 mm的赘生物占54.5％(12/22),＞15 mm的赘生物占31.8％ (7/22).最常见的致病微生物为念珠菌属,占68.2％ (15/22),其中白念珠菌占45.5％,近平滑念珠菌占9.1％；其次为曲霉菌属,占22.7％ (5/22),其中烟曲霉菌占9.1％.易患因素包括人工心脏瓣膜置换术后、免疫功能受损等.急性感染期间发生的严重并发症包括难治性心力衰竭、系统性栓塞、难以控制的感染和急性肾功能衰竭.住院病死率为40.9％ (9/22),主要死亡原因为难治性心力衰竭、脓毒症并发的多器官功能衰竭和脑卒中.15例患者经抗真菌药物治疗包括氟康唑、伊曲康唑、醋酸卡泊芬净和伏立康唑.7例(31.8％)患者接受了瓣膜置换术,其中3例为再次瓣膜置换术.接受内外科联合治疗的患者住院病死率较低(1/7).结论 FE在医疗相关性感染和免疫功能低下患者多见；栓塞事件发生率高,且赘生物体积大；住院病死率高,死因包括心力衰竭、脓毒症和反复的动脉栓塞.
目的 探討真菌性感染性心內膜炎(FE)患者的臨床特點、治療方式和預後.方法 連續入選2003-2009年阜外心血管病醫院符閤Duke診斷標準的真菌性心內膜炎患者,對其臨床特徵、微生物學特點、併髮癥和死亡原因等進行迴顧性分析.結果 共入選FE患者22例.中位年齡45歲,男女比例2.1∶1.13例(59.1％)患者為醫療相關性感染,1例靜脈吸毒相關感染.最常受纍的瓣膜是主動脈瓣(40.9％),其次是二尖瓣(13.6％).16例(72.7％)患者超聲心動圖髮現贅生物,＞10 mm的贅生物佔54.5％(12/22),＞15 mm的贅生物佔31.8％ (7/22).最常見的緻病微生物為唸珠菌屬,佔68.2％ (15/22),其中白唸珠菌佔45.5％,近平滑唸珠菌佔9.1％；其次為麯黴菌屬,佔22.7％ (5/22),其中煙麯黴菌佔9.1％.易患因素包括人工心髒瓣膜置換術後、免疫功能受損等.急性感染期間髮生的嚴重併髮癥包括難治性心力衰竭、繫統性栓塞、難以控製的感染和急性腎功能衰竭.住院病死率為40.9％ (9/22),主要死亡原因為難治性心力衰竭、膿毒癥併髮的多器官功能衰竭和腦卒中.15例患者經抗真菌藥物治療包括氟康唑、伊麯康唑、醋痠卡泊芬淨和伏立康唑.7例(31.8％)患者接受瞭瓣膜置換術,其中3例為再次瓣膜置換術.接受內外科聯閤治療的患者住院病死率較低(1/7).結論 FE在醫療相關性感染和免疫功能低下患者多見；栓塞事件髮生率高,且贅生物體積大；住院病死率高,死因包括心力衰竭、膿毒癥和反複的動脈栓塞.
목적 탐토진균성감염성심내막염(FE)환자적림상특점、치료방식화예후.방법 련속입선2003-2009년부외심혈관병의원부합Duke진단표준적진균성심내막염환자,대기림상특정、미생물학특점、병발증화사망원인등진행회고성분석.결과 공입선FE환자22례.중위년령45세,남녀비례2.1∶1.13례(59.1％)환자위의료상관성감염,1례정맥흡독상관감염.최상수루적판막시주동맥판(40.9％),기차시이첨판(13.6％).16례(72.7％)환자초성심동도발현췌생물,＞10 mm적췌생물점54.5％(12/22),＞15 mm적췌생물점31.8％ (7/22).최상견적치병미생물위념주균속,점68.2％ (15/22),기중백념주균점45.5％,근평활념주균점9.1％；기차위곡매균속,점22.7％ (5/22),기중연곡매균점9.1％.역환인소포괄인공심장판막치환술후、면역공능수손등.급성감염기간발생적엄중병발증포괄난치성심력쇠갈、계통성전새、난이공제적감염화급성신공능쇠갈.주원병사솔위40.9％ (9/22),주요사망원인위난치성심력쇠갈、농독증병발적다기관공능쇠갈화뇌졸중.15례환자경항진균약물치료포괄불강서、이곡강서、작산잡박분정화복립강서.7례(31.8％)환자접수료판막치환술,기중3례위재차판막치환술.접수내외과연합치료적환자주원병사솔교저(1/7).결론 FE재의료상관성감염화면역공능저하환자다견；전새사건발생솔고,차췌생물체적대；주원병사솔고,사인포괄심력쇠갈、농독증화반복적동맥전새.
Objective To explore the clinical characteristics,treatment regimens and outcomes of the patients with fungal infective endocarditis.Methods An observational study was conducted at our hospital and recruited 22 consecutive patients with a definite diagnosis of fungal infective endocarditis.Their overall characteristics,treatments,complications and outcomes were analyzed.Results The mean age at presentation was 45 years with a slight male preponderance.Among them,13 cases had heahhcareassociated infective endocarditis and 1 patient was an intravenous drug user.Aortic valve (40.9％) was most commonly affected and it was followed by mitral valve (13.6％).The most common etiological agent was Candida (68.2％),followed by Aspergillus (22.7％).Risk factors include the prosthetic valve replacement surgery,impaired immune function,and so on.Major complications during the acute infective phase were also recorded,including heart failure,embolic events,uncontrolled infections and renal dysfunction.The overall hospital mortality rate was 40.9％.There were 15 patients with antifungal treatment,which including fluconazole,itraconazole,caspofungin acetate and voriconazole itraconazole.The remaining 7 patients (31.8％) underwent valve replacement surgery,including 3 cases of cardiac valve rereplacement.A better outcome was observed in patients on a combined regimen of medical and surgical therapies.Conclusions Fungal endocarditis is associated with more invasive interventions and immunocompromised patients.The incidence of embolic events and in-hospital mortality is still high in patients with fungal endocarditis,and the larger vegetation is more common.Heart failure,sepsis and repeated arterial embolization are the most common cause of death.
