CAJ | 학술논문

目的描述医疗机构相关性感染性心内膜炎(HAIE)的特点,并分析引起感染性心内膜炎(IE)死亡的危险因素.方法连续收集1992年至2012年复旦大学附属华山医院确诊的IE患者,分为HAIE和社区获得性IE(CAIE),比较HAIE和CAIE的流行病学及临床特点.采用Logistic回归筛选引起IE患者住院死亡的危险因素.结果共纳入154例IE患者,其中126例为CAIE,占81.8％,28例为HAIE,占18.2％.HAIE与CAIE患者比较,发病前基础情况较差(Charlson合并症评分≥2分患者比例为35.7％比15.1％;x2=6.382,P=0.012),更多人造瓣膜置换史(35.7％比7.1％;x2=17.291,P＜0.01),风湿性心脏病史(35.7％比10.3％; x2=11.631,P=0.002),免疫抑制剂或糖皮质激素治疗史(21.4％比4.0％;x2=10.530,P=0.005)和并发急性心力衰竭(17.9％比4.8％;x2=5.923,P=0.029).CAIE以草绿色链球菌感染为主(x2=5.489,P=0.019),而HAIE以葡萄球菌、肠球菌感染为主(50.1％),其他病原体感染也多见于HAIE(x2 =5.870,P=0.026).住院期间共死亡10例,住院病死率为6.5％.HAIE的病死率显著高于CAIE(17.9％比4.0％;x2 =7.278,P=0.018).多因素回归分析表明,未手术治疗(OR=0.081,95％ CI:0.008～0.873,P=0.038)、低白蛋白水平(OR=0.754,95％CI:0.587～0.967,P=0.026)、脑卒中(OR=33.777,95％CI:2.751～414.743,P=0.006)和HAIE(OR=11.952,95％CI:1.045～136.709,P=0.046)是引起IE患者死亡的独立危险因素.结论 HAIE常见且流行病学特点有别于CAIE,可增加患者的病死率.
목적 묘술의료궤구상관성감염성심내막염(HAIE)적특점,병분석인기감염성심내막염(IE)사망적위험인소.방법 련속수집1992년지2012년복단대학부속화산의원학진적IE환자,분위HAIE화사구획득성IE(CAIE),비교HAIE화CAIE적류행병학급림상특점.채용Logistic회귀사선인기IE환자주원사망적위험인소.결과 공납입154례IE환자,기중126례위CAIE,점81.8％,28례위HAIE,점18.2％.HAIE여CAIE환자비교,발병전기출정황교차(Charlson합병증평분≥2분환자비례위35.7％비15.1％;x2=6.382,P=0.012),경다인조판막치환사(35.7％비7.1％;x2=17.291,P＜0.01),풍습성심장병사(35.7％비10.3％; x2=11.631,P=0.002),면역억제제혹당피질격소치료사(21.4％비4.0％;x2=10.530,P=0.005)화병발급성심력쇠갈(17.9％비4.8％;x2=5.923,P=0.029).CAIE이초록색련구균감염위주(x2=5.489,P=0.019),이HAIE이포도구균、장구균감염위주(50.1％),기타병원체감염야다견우HAIE(x2 =5.870,P=0.026).주원기간공사망10례,주원병사솔위6.5％.HAIE적병사솔현저고우CAIE(17.9％비4.0％;x2 =7.278,P=0.018).다인소회귀분석표명,미수술치료(OR=0.081,95％ CI:0.008～0.873,P=0.038)、저백단백수평(OR=0.754,95％CI:0.587～0.967,P=0.026)、뇌졸중(OR=33.777,95％CI:2.751～414.743,P=0.006)화HAIE(OR=11.952,95％CI:1.045～136.709,P=0.046)시인기IE환자사망적독립위험인소.결론 HAIE상견차류행병학특점유별우CAIE,가증가환자적병사솔.
Objective To describe the characteristics of healthcare-associated infective endocarditis (HAIE) and to investigate the risk factors of infective endocarditis (IE) case fatality.Methods All consecutive cases of definite IE diagnosed from 1992 to 2012 were collected and categorized into HAIE and community acquired IE (CAIE).The epidemiological and clinical features of HAIE and CAIE were compared.Risk factors for in-hospital case fatality were analyzed by Logistic regression.Results One hundred and fifty-four patients with IE were enrolled; 126 (81.8％) were CAIE and 28 (18.2％) were HAIE.Compared with CAIE patients,HAIE patients were in poorer condition (Charlson comorbidity scale≥2:35.7％ vs 15.1％;x2 =6.382,P=0.012),more frequently associated with a history of prosthetic valve replacement (35.7 ％ vs 7.1％ ; x2 =17.291,P＜0.01),more rheumatic heart disease (35.7 ％ vs 10.3 ％ ; x2 =11.631,P=0.002),more recieved immunosuppressive or glucocorticoid therapy (21.4％ vs 4.0％; x2 =10.530,P=0.005) and more acute heart failure (17.9％ vs 4.8％; x2=5.923,P=0.029).Viridans group streptococci infection predominated in CAIE (x2 =5.489,P=0.019),while staphylococci and enterococci infections (50.1％) were frequent in HAIE.Other bacterial pathogen infections were more common in HAIE (x2 =5.870,P=0.026).Ten patients died before discharge and the case fatality rate in-hospital was 6.5％ (10/154).Case fatality rate in HAIE (17.9％) was significantly higher than CAIE (4.0％ x2 =7.278,P=0.018).Surgery treatment,albumin level,stroke and HAIE were independent risk factors for IE-related deaths.Odds ratios (OR) were 0.081 (95 ％ CI:0.008-0.873),0.754 (95％CI:0.587-0.967),33.777 (95％CI:2.751-414.743) and 11.952 (95％CI:1.045-136.709),respectively.Conclusion HAIE is common and distinctive from CAIE in epidemiology and prognosis,which increases patient fatality.