Levitt M A, Snoey E R, Tamkin G W, Gee G
Department of Emergency Medicine, Alameda County Medical Center, Oakland, CA 94602, USA.
Acad Emerg Med. 1999 Sep;6(9):911-5. doi: 10.1111/j.1553-2712.1999.tb01240.x.
To determine the prevalence of occult valvular pathology in afebrile injection drug users (IDUs) compared with an afebrile, non-IDU population. To characterize the type of valvular pathology present in light of current recommendations regarding periprocedural antibiotic prophylaxis against endocarditis.
This was a comparative, cross-sectional study involving a convenience sample of 98 patients with a history of injection drug use, and 99 non-IDU patients presenting to a large urban ED. Patients were excluded if they had one or more of the following: a history of cardiac valve abnormality, a history of endocarditis, fever on presentation, or a cardiac murmur. Data were collected that included demographics, medical history, and details of injection drug use. Transthoracic echocardiography (echo) was performed on each subject in the ED, and read in a blinded fashion by a single board-certified cardiologist.
Among 98 IDUs and 99 non-IDUs, 12% of the IDUs had aortic valve thickening, compared with 5.1% of the non-IDUs (99% CI for difference of 7.8% = -3.0% to 18.6%). Forty-four percent of the IDUs had mitral valve thickening, compared with 25% of the non-IDUs (99% CI for difference of 18.3% = 0.9% to 35.7%). Eleven percent of the IDUs vs 1% of the non-IDUs had tricuspid valve thickening (99% CI for difference of 10.4% = 1.6% to 19.2%). No patient had pulmonic valve thickening. Six percent of the IDUs vs 0% of the non-IDUs had mitral annulus thickening (99% CI for difference of 6.3% = -0.1% to 12.8%). Twelve percent of the IDUs vs 3% of the non-IDUs had mitral chordae thickening (99% CI for difference of 9.5% = -0.4% to 19.4%). Tricuspid chordae thickening was recorded in 2% of the IDUs vs 0% of the non-IDUs (99% CI for difference of 2.1% = -1.7% to 6.0%). Most important, the prevalence of valvular regurgitation was small, and evenly distributed in the two groups. No valvular vegetations were seen.
Both non-IDUs and IDUs have occult valvular pathology. There is an increased prevalence in IDUs of tricuspid and mitral valve thickening. The prevalence of valvular regurgitation, a reported indication for periprocedural antibiotic prophylaxis, was small and the affected valves were not statistically different between the two groups. These findings question the selected routine use of antibiotic prophylaxis in IDU patients undergoing invasive procedures.
确定与无发热的非注射吸毒者人群相比，无发热的注射吸毒者（IDU）隐匿性瓣膜病变的患病率。根据目前关于围手术期预防心内膜炎使用抗生素的建议，对存在的瓣膜病变类型进行特征描述。
这是一项对比性横断面研究，纳入了98例有注射吸毒史患者和99例非注射吸毒患者的便利样本，这些患者均就诊于一家大型城市急诊科。如果患者有以下一项或多项情况则被排除：心脏瓣膜异常病史、心内膜炎病史、就诊时发热或心脏杂音。收集的数据包括人口统计学资料、病史以及注射吸毒的详细情况。在急诊科对每位受试者进行经胸超声心动图（超声）检查，并由一名具有专业资格认证的心脏病专家以盲法解读检查结果。
在98例注射吸毒者和99例非注射吸毒者中，12%的注射吸毒者有主动脉瓣增厚，而非注射吸毒者中这一比例为5.1%（差异的99%置信区间为7.8% = -3.0%至18.6%）。44%的注射吸毒者有二尖瓣增厚，而非注射吸毒者中这一比例为25%（差异的99%置信区间为18.3% = 0.9%至35.7%）。11%的注射吸毒者有三尖瓣增厚，而非注射吸毒者中这一比例为1%（差异的99%置信区间为10.4% = 1.6%至19.2%）。没有患者有肺动脉瓣增厚。6%的注射吸毒者有二尖瓣环增厚，而非注射吸毒者中这一比例为0%（差异的99%置信区间为6.3% = -0.1%至12.8%）。12%的注射吸毒者有二尖瓣腱索增厚，而非注射吸毒者中这一比例为3%（差异的99%置信区间为9.5% = -0.4%至19.4%）。2%的注射吸毒者有三尖瓣腱索增厚，而非注射吸毒者中这一比例为0%（差异的99%置信区间为2.1% = -1.7%至6.0%）。最重要的是，瓣膜反流的患病率较低，且在两组中分布均匀。未发现瓣膜赘生物。
非注射吸毒者和注射吸毒者均有隐匿性瓣膜病变。注射吸毒者中三尖瓣和二尖瓣增厚的患病率增加。瓣膜反流是围手术期预防性使用抗生素的一个报告指征，其患病率较低，且两组中受影响的瓣膜在统计学上无差异。这些发现对在接受侵入性操作的注射吸毒者患者中常规使用抗生素预防提出了质疑。
