2018 年第 2 期 第 13 卷

血培养阳性感染性心内膜炎患者的临床特点及预后影响因素

作者：王珊朱光发

英文作者：

单位：100029首都医科大学附属北京安贞医院感染科

英文单位：

关键词：感染性心内膜炎；血培养

英文关键词：

• 摘要：

• 目的    探讨血培养阳性感染性心内膜炎患者的临床特点及预后影响因素。方法    回顾性分析2013年7月至2015年11月首都医科大学附属北京安贞医院收治的244例感染性心内膜炎患者的临床资料，根据血培养结果分为血培养阳性组（86例）和血培养阴性组（158例），重点分析血培养阳性组患者临床特点、病原菌分布及耐药性，统计患者转归并分析其影响因素。结果    2组患者基础病因均以先天性心脏病为主，血培养阳性组中室间隔缺损［50.0%（43/86）］占第1位，血培养阴性组中主动脉瓣二叶畸形［54.4%（86/158）］占第1位。发热及心脏杂音为主要临床特征，发热比例在血培养阳性组和血培养阴性组间差异有统计学意义［94.2%（81/86）比77.8%（123/158）］（P<0.05）。脏器栓塞中以脑梗死为最常见［血培养阴性组7.6%（12/158），血培养阳性组14.0%（12/86）］。血培养阳性组的红细胞沉降率及C反应蛋白水平升高比例高于血培养阴性组，差异有统计学意义（P<0.05）。血培养阳性组患者病原菌以链球菌、葡萄球菌为主，分别占57.0%(49/86)和20.9%(18/86)。链球菌、葡萄球菌及肠球菌对红霉素和克林霉素的耐药率较高，葡萄球菌另对青霉素的耐药率较高，未发现对万古霉素及利奈唑胺耐药菌株。86例患者死亡4例，心脏手术史、心力衰竭（纽约心脏病协会心功能分级Ⅲ～Ⅳ级）、赘生物（≥15 mm）为死亡危险因素（P<0.05）。结论    感染性心内膜炎血培养阳性缺乏临床特异性表现，实验室检查有助于明确病因，可根据病例特征大致判定预后。

• Clinical features and prognostic factors of positive blood culture infective endocarditis

  Wang Shan, Zhu Guangfa

  Department of Infectious Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

  Corresponding author: Zhu Guangfa, Email: gfzhu6388@sina.com

  【Abstract】Objective    To investigate clinical features and prognostic factors of positive blood culture infective endocarditis. Methods    Clinical data of 244 cases of infective endocarditis admitted in Beijing Anzhen Hospital, Capital Medical University from July 2013 to November 2015 were retrospectively analyzed, and the patients were divided into positive blood culture group（86 cases） and negative blood culture group（158 cases）. Clinical features, pathogenic distribution, drug resistance, and influence factors of prognosis were analyzed. Results    Congenital heart disease was the main basic disease in both groups; ventricular septal defect［50.0%（43/86）］ was the main basic disease in positive blood culture group and bicuspid aortic valve［54.4%（86/158）］ was the main basic disease in negative blood culture group. Fever and cardiac murmur were the most common clinical presentations; incidence of fever showed a significant difference between positive blood culture group and negative blood culture group［94.2%（81/86） vs 77.8%（123/158）］（P<0.05）. Cerebral infarction was the most common presentation of thromboembolism in major organs; incidence of cerebral infarction was 7.6%（12/158） in positive blood culture group and 14.0%（12/86） in negative blood culture group. Erythrocyte sedimentation rate and C-reactive protein elevation in blood culture positive group were significantly higher than those in negative blood culture group（P<0.05）. Streptococcus and staphylococcus were the major pathogens in positive blood culture group, accounting for 57.0%(49/86) and 20.9%(18/86) respectively. Streptococcus, staphylococcus and enterococcus were highly resistant to erythromycin and clindamycin; staphylococcus was highly resistant to penicillin; all pathogens were sensitive to vancomycin and linezolid. There were 4 deaths in 86 patients; history of cardiac surgery, heart failure(New York Heart Association class Ⅲ-Ⅳ) and vegetation(≥15 mm) were risk factors of death（P<0.05）. Conclusion    Due to lack of specific clinical manifestations of positive blood culture infective endocarditis, laboratory indicators may help to determine the cause of disease, and characteristics of infective endocarditis may roughly determine the prognosis.

  【Key words】Infective endocarditis;Blood culture