González-Juanatey C, González-Gay M A, Llorca J, Crespo F, García-Porrúa C, Corredoira J, Vidán J, González-Juanatey J R
Division of Cardiology, Hospital Xeral-Calde, Lugo, Spain.
Medicine (Baltimore). 2001 Jan;80(1):9-19. doi: 10.1097/00005792-200101000-00002.
Infective endocarditis (IE) is due to a microbial infection of the heart valves or of the endocardium in close proximity to either congenital or acquired cardiac defects. This infection is associated with a high risk of complications. Rheumatic manifestations are known to be frequent complications of IE. Controversy, however, frequently exists about the actual incidence of these complications. This may be due to the small number of series describing the frequency and type of rheumatic manifestations, the absence of uniform criteria used for the diagnosis of IE, and the fact that some studies on rheumatic manifestations in IE have been described from tertiary referral centers, which implicates associated problems of referral bias and uncertainty of denominator population. To investigate further the incidence, clinical spectrum, and outcome of patients with IE and rheumatic manifestations, we examined the features of patients diagnosed with clinically definite IE according to the Duke classification criteria at the single reference hospital for a defined population in northwestern Spain during a 12-year period. Between 1987 and 1998, 100 consecutive patients had 110 episodes of clinically definite IE. Rheumatic manifestations were observed in 46 of the 110 episodes (41.8%). As in other western countries, they occurred more commonly in men aged in their 50s. The most frequent valve involved was the aortic (43.5%) followed by the mitral valve (30.4%). Myalgia was a frequent symptom. Peripheral arthritis, generally as monoarthritis, was clinically evident in 15 cases (13.6%), and sacroiliitis in 1 patient. Low back pain was described in 14 cases (12.7%). Septic discitis was observed in 2 cases, and biopsy-proved cutaneous leukocytoclastic vasculitis was found in 4 cases. Other conditions such as trochanteric bursitis and polymyalgia were observed in 2 and 1 case, respectively. Apart from a significantly higher frequency of hematuria and a trend to lower serum complement levels in patients with rheumatic complications, no differences in clinical features, laboratory tests, or microbiologic blood culture results were found between cases with IE with or without rheumatic manifestations. Also, although patients with rheumatic manifestations had more embolic complications, the inhospital mortality rate in patients with rheumatic manifestations was not significantly different from that of the rest of the patients. The present study supports the claim that rheumatic complications are frequent in patients with clinically definite IE from southern Europe. The presence of musculoskeletal or vasculitic manifestations may be of some help, as warning signs, for the recognition of patients with severe disease who require rapid diagnosis and therapy.
感染性心内膜炎（IE）是由微生物感染心脏瓣膜或紧邻先天性或后天性心脏缺损的内膜所致。这种感染与高并发症风险相关。风湿表现是IE常见的并发症。然而，对于这些并发症的实际发生率常常存在争议。这可能是由于描述风湿表现频率和类型的系列研究数量较少、缺乏用于诊断IE的统一标准，以及一些关于IE风湿表现的研究是从三级转诊中心描述的，这涉及转诊偏倚和分母人群不确定性的相关问题。为了进一步研究IE合并风湿表现患者的发生率、临床谱和结局，我们在西班牙西北部一家单一的参考医院，对特定人群中根据杜克分类标准诊断为临床确诊IE的患者特征进行了为期12年的研究。1987年至1998年期间，100例连续患者发生了110次临床确诊的IE发作。在110次发作中有46次（41.8%）观察到风湿表现。与其他西方国家一样，它们更常见于50多岁的男性。受累最频繁的瓣膜是主动脉瓣（43.5%），其次是二尖瓣（30.4%）。肌痛是常见症状。外周关节炎通常为单关节炎，15例（13.6%）临床明显，1例有骶髂关节炎。14例（12.7%）描述有腰痛。2例观察到化脓性椎间盘炎，4例发现活检证实的皮肤白细胞破碎性血管炎。分别有2例和1例观察到其他情况，如转子滑囊炎和风湿性多肌痛。除了风湿并发症患者血尿频率显著更高以及血清补体水平有降低趋势外，有或无风湿表现的IE患者在临床特征、实验室检查或微生物血培养结果方面未发现差异。此外，尽管有风湿表现的患者栓塞并发症更多，但有风湿表现患者的住院死亡率与其他患者无显著差异。本研究支持这样的观点，即来自南欧临床确诊IE的患者风湿并发症很常见。肌肉骨骼或血管炎表现的存在可能有助于作为警示信号，识别需要快速诊断和治疗的重症患者。
