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| 先天性心脏病合并感染性心内膜炎58例临床分析 |
| 王贵明12△,朱玉峰1△,张本3△,陈翔1,白元1,王韦4,吴弘1,徐志云3,赵仙先1*,秦永文1* |
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(1. 第二军医大学长海医院心血管内科, 上海 200433;
2. 广东省第二人民医院病理科, 广州 510317;
3. 第二军医大学长海医院胸心外科, 上海 200433;
4. 第二军医大学长海医院超声科, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的：分析先天性心脏病(先心病)合并感染性心内膜炎患者的病种构成及临床病理特点。方法：收集2010年1月至2013年12月年长海医院经外科手术切除、病理学确诊的先心病合并感染性心内膜炎的病例,收集患者的相关临床资料,统计先心病的疾病类型,分析临床病理学特点。结果：先心病合并感染性心内膜炎58例,占同期所有感染性心内膜炎的33.7%(58/172),平均年龄(28.3±7.3)岁。位列前三位的先心病类型为主动脉瓣二叶畸形占34.5％(20/58),室间隔缺损占20.7%(12/58),动脉导管未闭占15.5%(9/58),其他先心病(包括主动脉瓣狭窄、主动脉瓣下狭窄、主动脉窦瘤右室瘘、二尖瓣狭窄、二尖瓣关闭不全、肺动脉瓣狭窄)占13.8%(8/58),复杂CHD(含2种以上畸形)占15.5%(9/58)。主动脉瓣二叶畸形患者年龄高于其他先心病合并感染性心内膜炎患者年龄[(38.7±11.7)岁 VS (26．6±12．4)岁,P＜0.05]。血培养阳性率为42.1％(25／58),其中草绿色链球菌占48.0％(12／25)。58例患者均行经胸超声检查,阳性诊断率为96.6％(56/58),赘生物累及多个部位较为常见,分病种来看,在主动脉二叶畸形患者多累及主动脉瓣,在室间隔缺损多累及三尖瓣隔瓣和VSD右室面,动脉导管未闭患者累及主动脉瓣、动脉导管开口处或分流冲刷的肺动脉左侧壁。结论：先心病已经成为感染性心内膜炎的常见的基础疾病,其中以主动脉瓣二叶畸形最为常见,室间隔缺损、动脉导管未闭也占据较高比例。患者血培养阳性率低,超声是比较可靠的诊断技术,不同病种赘生物累及的部位不同,累及多个部位比较常见。 |
| 关键词: 先天性心脏缺损 细菌性心内膜炎 病理学 疾病谱 |
| DOI：10.3724/SP.J.1008.2015.00463 |
| 投稿时间：2014-08-08修订日期：2014-10-28 |
| 基金项目:] |
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| Congenital heart disease combined with infective endocarditis: a clinical analysis of 58 cases |
| WANG Gui-ming1 2△,ZHU Yu-feng1△,ZHANG Ben3△,CHEN Xiang1,BAI Yuan1,WANG Wei4,WU Hong1,XU Zhi-yun3,ZHAO Xian-xian1*,QIN Yong-wen1* |
(1. Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Pathology, the Second People's Hospital of Guangdong, Guangzhou 510317, Guangdong, China;
3. Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
4. Department of Ultrasound, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding authors) |
| Abstract: |
| Objective To assess disease spectrum and clinico-pathological characteristics of infective endocarditis(IE) in patients with congenital heart disease(CHD). Methods Clinical characteristics of IE patients with CHD were investigated,who were receiving surgical treatment and pathological diagnosis during 2010.01-2013.12 in Changhai hospital. The clinical datas，disease species and clinico-pathological characteristics were retrospectively analyzed. Results During these 4 years, there were 58 IE cases associated with CHD whose mean age is (28.3±7.3)years accounting for 33.7％(58/172) of all patients with IE receiving surgical treatment. The top three types of congenital heart disease were included bicuspid aortic valve accounted for 34.5% (20/58), ventricular septal defect(VSD) accounted for 20.7% (12/58) and patent ductus arteriosus(PDA) accounted for 15.5% (9/58). Other congenital heart diseases (including aortic stenosis, subaortic stenosis, aortic sinus aneurysm right ventricular fistula, mitral stenosis, mitral incompetence and pulmonary stenosis) accounted for 13.8% (8/58),while complex CHD (containing two or more abnormalities) accounted for 15.5% (9/58). Mean age of bicuspid aortic valve patient was higher than other CHD patients with infective endocarditis [(38.7 ± 11.7) years vs (26.6 ± 12.4) years, P <0.05]. Positive rate of blood culture were 42.1% (25/58),in which viridans accounted for 48.0%(12/25). Echocardiography was performed in all patients and the positive rate was 96.6%(56/58) It was common that excrescence attached multiple sites, For patients with bicuspid aortic valve, excrescence often attached aortic valve, for VSD patients, excrescence often attached tricuspid septal leaflet and VSD right ventricular surface,while for PDA patients,was aortic valve,opening of PDA or the left pulmonary artery wall eroded by shunt. Conclusion CHD is common underlying disease for IE , in which bicuspid aortic valve ranks first, VSD and PDA also occupy a high proportion. Blood culture positive rate is low, while transthoracic echocardiography(TTE) is recommended as a reliable inspection techniques. Different diseases have different parts of the vegetation involving, more common is that multiple sites are involved. |
| Key words: congenital heart defects bacterial endocarditis pathology disease spectrum |
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