Jia Y, Fang F, Wang H
Department of Cardiology, Beijing Hospital, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2017 Oct 1;56(10):725-728. doi: 10.3760/cma.j.issn.0578-1426.2017.10.003.
To study the characteristics and misdiagnosis of infective endocarditis (IE). Clinical and pathological data of 15 IE patients diagnosed by autopsy were collected, compared with the cohort of 29 regular IE cases. In the autopsy patients, IE in the left heart was predominat (14/15, 93.3%). Arterial embolism was the most common comorbidity (10/15, 66.7%), followed by pneumonia, malignancies, pyelonephritis (9/15, 60.0%; 7/15, 46.7%; 6/15, 40.0% respectively). The age was elder [(64.0±21.2)years vs(50.8±18.3)years, =-2.15, =0.037] in autopsy patients than in control group. More patients of missed diagnosis were combined with malignancies or deep vein catheterization [7/15(46.7%)vs 1/29(3.4%); 5/15(33.3%)vs 0/29(0)respectively]. Fever and cardiac murmur were rare in misdiagnosed cases[11/15(73.7%)vs 28/29(96.9%), 0/15(0)vs 15/29(51.7%) respectively]. Echocardiography and blood culture were performed in only 33.3%(5/15) and 26.7%(4/15) cases of missed diagnosis with low positive rates compared with regular IE patients [0/15(0) vs 27/29 (93.1%); 1/15(6.7%) vs 15/29(55.6%)]. Infective endocarditis should be suspected in patients with the risk factors of IE even without fever or cardiac murmur. Echocardiography and blood culture should be done as screening tests of IE.
研究感染性心内膜炎（IE）的特点及误诊情况。收集15例经尸检确诊的IE患者的临床及病理资料，并与29例常规IE病例组进行比较。尸检患者中，左心IE占主导（14/15，93.3%）。动脉栓塞是最常见的合并症（10/15，66.7%），其次是肺炎、恶性肿瘤、肾盂肾炎（分别为9/15，60.0%；7/15，46.7%；6/15，40.0%）。尸检患者的年龄比对照组大[（64.0±21.2）岁 vs（50.8±18.3）岁，t=-2.15，P=0.037]。更多漏诊患者合并恶性肿瘤或深静脉置管[分别为7/15（46.7%） vs 1/29（3.4%）；5/15（33.3%） vs 0/29（0）]。漏诊病例中发热和心脏杂音少见[分别为11/15（73.7%） vs 28/29（96.9%），0/15（0） vs 15/29（51.7%）]。漏诊病例中仅33.3%（5/15）进行了超声心动图检查，26.7%（4/15）进行了血培养，与常规IE患者相比阳性率较低[0/15（0） vs 27/29（93.1%）；1/15（6.7%） vs 15/29（55.6%）]。即使没有发热或心脏杂音，对于有IE危险因素的患者也应怀疑感染性心内膜炎。应进行超声心动图和血培养作为IE的筛查检查。
