Kreuzpaintner G, Horstkotte D, Heyll A, Lösse B, Strohmeyer G
Department of Gastroenterology, Heinrich-Heine-University Düsseldorf, Germany.
Am J Med. 1992 Apr;92(4):391-5. doi: 10.1016/0002-9343(92)90269-h.
The purpose of this retrospective as well as prospective case-control study was to analyze a possible overrepresentation of inflammatory bowel diseases among patients with native valve endocarditis as well as the factors that predispose patients with inflammatory bowel disease to infective endocarditis.
Among 213 consecutive patients treated for proven native valve endocarditis, six (2.8%) had inflammatory bowel diseases (three with ulcerative colitis and three with Crohn's disease). Three patients with inflammatory bowel disease were from the retrospective group, and three were from the prospective group. The prevalence of inflammatory bowel diseases has been determined to be 0.0641% in the Düsseldorf area.
On the basis of these data, a 44-fold overrepresentation of inflammatory bowel diseases among the 213 patients with endocarditis was calculated with a statistical significance of p much less than 0.001.
Inflammatory bowel disease may be considered an independent risk factor for bacterial endocarditis. Reasons may be more frequent bacteremias as a result of the higher incidence of diagnostic and therapeutic interventions, as well as increased permeability of the damaged mucosa for bacteria and the therapeutic immunosuppression in patients with active inflammatory bowel disease. Prophylaxis for bacterial endocarditis should be carefully considered before expected bacteremias in patients with highly active inflammatory bowel disease even in the absence of cardiac factors predisposing to bacterial endocarditis.
本回顾性及前瞻性病例对照研究旨在分析患有自身瓣膜性心内膜炎的患者中炎症性肠病可能存在的过度代表性情况，以及使炎症性肠病患者易患感染性心内膜炎的因素。
在连续接受治疗的213例确诊自身瓣膜性心内膜炎患者中，6例（2.8%）患有炎症性肠病（3例溃疡性结肠炎，3例克罗恩病）。3例炎症性肠病患者来自回顾性组，3例来自前瞻性组。已确定在杜塞尔多夫地区炎症性肠病的患病率为0.0641%。
基于这些数据，计算出在213例心内膜炎患者中炎症性肠病的代表性高出44倍，统计学显著性为p远小于0.001。
炎症性肠病可被视为细菌性心内膜炎的一个独立危险因素。原因可能是由于诊断和治疗干预的发生率较高导致菌血症更频繁，以及受损黏膜对细菌的通透性增加，还有活动性炎症性肠病患者的治疗性免疫抑制。对于高度活动性炎症性肠病患者，即使在没有易患细菌性心内膜炎的心脏因素的情况下，在预期发生菌血症之前也应仔细考虑细菌性心内膜炎的预防措施。
