Cecchi Enrico, Imazio Massimo, Tidu Massimo, Forno Davide, De Rosa Francesco Giuseppe, Dal Conte Ivano, Preziosi Costantina, Lipani Filippo, Trinchero Rita
Cardiology Department, Maria Vittoria Hospital, Turin, Italy.
J Cardiovasc Med (Hagerstown). 2007 Mar;8(3):169-75. doi: 10.2459/01.JCM.0000260824.14596.86.
Intravenous drug users (IVDUs) are at increased risk of infective endocarditis. Moreover, HIV infection is common in IVDUs, with a reported prevalence of 40-90%. The clinical features of IVDUs with infective endocarditis and HIV infection may be peculiar. Few data have been reported on the diagnostic accuracy of Duke criteria in IVDUs with or without HIV infection, and a comparison of these two populations is lacking.
The present study aimed to compare prospectively the clinical features of patients with infective endocarditis with or without HIV infection and to evaluate the diagnostic accuracy of Duke criteria in these patients. The study population consisted of 201 consecutive adult IVDUs with a suspected infective endocarditis (102 patients with HIV infection and 99 patients without HIV infection).
Infective endocarditis was the final diagnosis in 40 of 102 patients (38.2%) with HIV infection and in 55 of 99 HIV-negative patients (55.6%). Despite similar baseline features, longer vegetations were recorded in infective endocarditis without HIV infection (23.7 +/- 7.1 mm versus 13.6 +/- 6.8 mm; P = 0.001). Patients with infective endocarditis and HIV infection had a higher total mortality at 2 months (respectively 12.5% versus 1.8%; P = 0.09); almost all the deaths were recorded in patients with AIDS or a CD4 cell count below 200 per microl, and no deaths were recorded in patients with HIV infection and a CD4 cell count > 500 per microl.
Despite no identical clinical features, Duke criteria had a similar sensitivity, specificity and diagnostic accuracy in IVDUs with and without HIV infection.
静脉注射吸毒者（IVDUs）感染性心内膜炎的风险增加。此外，HIV感染在IVDUs中很常见，报告的患病率为40%-90%。合并感染性心内膜炎和HIV感染的IVDUs的临床特征可能较为特殊。关于有或无HIV感染的IVDUs中杜克标准的诊断准确性的数据报道较少，且缺乏对这两组人群的比较。
本研究旨在前瞻性比较有或无HIV感染的感染性心内膜炎患者的临床特征，并评估杜克标准在这些患者中的诊断准确性。研究人群包括201例连续的疑似感染性心内膜炎的成年IVDUs（102例HIV感染患者和99例无HIV感染患者）。
102例HIV感染患者中有40例（38.2%）最终诊断为感染性心内膜炎，99例HIV阴性患者中有55例（55.6%）最终诊断为感染性心内膜炎。尽管基线特征相似，但无HIV感染的感染性心内膜炎患者的赘生物更长（分别为23.7±7.1mm对13.6±6.8mm；P=0.001）。感染性心内膜炎合并HIV感染的患者在2个月时的总死亡率较高（分别为12.5%对1.8%；P=0.09）；几乎所有死亡病例均记录在艾滋病患者或CD4细胞计数低于每微升2×10⁶的患者中，而CD4细胞计数>每微升5×10⁶的HIV感染患者中无死亡病例记录。
尽管临床特征不完全相同，但杜克标准在有和无HIV感染的IVDUs中具有相似的敏感性、特异性和诊断准确性。
