Agarwal R, Bahl V K, Malaviya A N
Department of Medicine, All India Institute of Medical Sciences, New Delhi.
J Assoc Physicians India. 1992 Nov;40(11):721-3.
The clinical profile of 28 consecutive patients admitted with infective endocarditis (IE) between 1987 and 1988 was studied. There were 21 males and seven females with a mean age of 24 +/- 11 years. Rheumatic heart disease (RHD) was the commonest underlying disease (68%) followed by congenital heart disease (CHD). Mitral regurgitation with aortic regurgitation were the commonest valvular lesions (47%) in those with RHD while ventricular septal defect was the commonest (43%) in those with CHD. A younger age of onset, complicated course and high mortality were seen in these six patients with acute IE. Persistently positive blood cultures during life or at autopsy were obtained in 21%. Strep viridans was the commonest isolate and was often resistant to streptomycin. 2D echocardicgram revealed vegetations in 96% of patients, the aortic valve (39%) being more commonly affected than the mitral valve (11%). ESR of more than 20 mm drop 1st hour (Wintrobe) was seen in 96%. Thrombophlebitis was a common complication of therapy and cloxacillin the commonest drug implicated. A mortality of 21% as a result of refractory congestive heart failure (CHF) (50%), uncontrolled sepsis (33%) and embolic events (17%) was seen. A rising incidence of culture negative IE, combined aortic and mitral valve disease and CHF is noted.
对1987年至1988年间连续收治的28例感染性心内膜炎（IE）患者的临床资料进行了研究。其中男性21例，女性7例，平均年龄24±11岁。风湿性心脏病（RHD）是最常见的基础疾病（68%），其次是先天性心脏病（CHD）。在患有RHD的患者中，二尖瓣反流合并主动脉瓣反流是最常见的瓣膜病变（47%），而在患有CHD的患者中，室间隔缺损是最常见的（43%）。这6例急性IE患者发病年龄较轻，病程复杂，死亡率高。21%的患者在生前或尸检时血培养持续阳性。草绿色链球菌是最常见的分离菌，且常对链霉素耐药。二维超声心动图显示96%的患者有赘生物，主动脉瓣（39%）比二尖瓣（11%）更常受累。96%的患者第1小时血沉（温氏法）超过20mm。血栓性静脉炎是治疗的常见并发症，最常涉及的药物是氯唑西林。因难治性充血性心力衰竭（CHF）（50%）、无法控制的败血症（33%）和栓塞事件（17%）导致的死亡率为21%。培养阴性IE、主动脉瓣和二尖瓣联合病变以及CHF的发病率呈上升趋势。
