Sun Xiao-lu, Zhang Jian, Wang Guo-gan, Zhuang Xiao-feng
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China.
Zhonghua Yi Xue Za Zhi. 2013 Feb 26;93(8):569-73.
To explore the clinical characteristics, treatment regimens and outcomes of the patients with fungal infective endocarditis.
An observational study was conducted at our hospital and recruited 22 consecutive patients with a definite diagnosis of fungal infective endocarditis. Their overall characteristics, treatments, complications and outcomes were analyzed.
The mean age at presentation was 45 years with a slight male preponderance. Among them, 13 cases had healthcare-associated infective endocarditis and 1 patient was an intravenous drug user. Aortic valve (40.9%) was most commonly affected and it was followed by mitral valve (13.6%). The most common etiological agent was Candida (68.2%), followed by Aspergillus (22.7%). Risk factors include the prosthetic valve replacement surgery, impaired immune function, and so on. Major complications during the acute infective phase were also recorded, including heart failure, embolic events, uncontrolled infections and renal dysfunction. The overall hospital mortality rate was 40.9%. There were 15 patients with antifungal treatment, which including fluconazole, itraconazole, caspofungin acetate and voriconazole itraconazole. The remaining 7 patients (31.8%) underwent valve replacement surgery, including 3 cases of cardiac valve re-replacement. A better outcome was observed in patients on a combined regimen of medical and surgical therapies.
Fungal endocarditis is associated with more invasive interventions and immunocompromised patients. The incidence of embolic events and in-hospital mortality is still high in patients with fungal endocarditis, and the larger vegetation is more common. Heart failure, sepsis and repeated arterial embolization are the most common cause of death.
探讨真菌性感染性心内膜炎患者的临床特征、治疗方案及预后。
在我院进行一项观察性研究，连续纳入22例确诊为真菌性感染性心内膜炎的患者。分析他们的总体特征、治疗情况、并发症及预后。
发病时的平均年龄为45岁，男性略占优势。其中，13例为医疗相关感染性心内膜炎，1例为静脉吸毒者。主动脉瓣（40.9%）最常受累，其次是二尖瓣（13.6%）。最常见的病原体是念珠菌（68.2%），其次是曲霉菌（22.7%）。危险因素包括人工瓣膜置换手术、免疫功能受损等。还记录了急性感染期的主要并发症，包括心力衰竭、栓塞事件、感染控制不佳及肾功能不全。总体医院死亡率为40.9%。15例患者接受了抗真菌治疗，包括氟康唑、伊曲康唑、醋酸卡泊芬净和伏立康唑。其余7例患者（31.8%）接受了瓣膜置换手术，其中3例为心脏瓣膜再次置换。药物和手术联合治疗的患者预后较好。
真菌性心内膜炎与更多的侵入性干预措施及免疫功能低下患者有关。真菌性心内膜炎患者的栓塞事件发生率和住院死亡率仍然很高，且较大的赘生物更为常见。心力衰竭、脓毒症和反复动脉栓塞是最常见的死亡原因。
