中国一家三级医院感染性心内膜炎发病特征的变迁：2001 年至 2018 年的回顾性研究。
A changing profile of infective endocarditis at a tertiary hospital in China: a retrospective study from 2001 to 2018.
机构信息
Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
出版信息
BMC Infect Dis. 2019 Nov 8;19(1):945. doi: 10.1186/s12879-019-4609-8.
BACKGROUND
Infective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE at a tertiary hospital in south China over a period of nearly 18 years.
METHODS
Medical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital of Southern Medical University. Data were divided by admission time into two groups equally: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018.
RESULTS
A Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDUs), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher proportion of positive microbiological findings compared with the early-period group. The in-hospital mortality remained about the same between the two periods and the multivariate analysis identified intravenous drug addicted, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insufficiency, left-sided endocarditis, early surgical as independent predictors of in-hospital mortality.
CONCLUSIONS
Our study demonstrated a dramatic change in the profile of IE over a period of 18 years at a tertiary hospital in south China and presented several independent predictors of in-hospital mortality. The geographic variations observed in our study will be of important value to profile the clinical feature of China and offer the reference for clinical decisions in our region.
背景
感染性心内膜炎（IE）是一种致命疾病，在过去几十年中发生了显著变化；然而，中国关于 IE 的信息仍然很少。本研究调查了中国南方一家三级医院近 18 年来 IE 的临床特征变化。
方法
从南方医科大学南方医院电子病历系统中选择 2001 年 6 月至 2018 年 6 月连续住院的 IE 患者的病历记录。根据入院时间将数据分为两组：早期组，2001 年 6 月至 2009 年 12 月；晚期组，2010 年 1 月至 2018 年 7 月。
结果
本研究共纳入 313 例 IE 患者。与早期组相比，晚期组患者中静脉吸毒者（IVDU）较少，发病年龄较大，肺栓塞发生率降低，肾功能不全较少，金黄色葡萄球菌感染比例降低，超声心动图检查右心赘生物较少。与早期组相比，晚期组患者的缺血性脑卒中比例较高，微生物学阳性检出率也较高。两组患者住院死亡率相近，多因素分析显示静脉吸毒、人工瓣膜心内膜炎、出血性脑卒中、急性充血性心力衰竭、肾功能不全、左侧心内膜炎、早期手术是住院死亡率的独立预测因素。
结论
本研究表明，中国南方一家三级医院在 18 年期间 IE 的发病情况发生了显著变化，并提出了几个与住院死亡率相关的独立预测因素。本研究观察到的地域差异对于了解中国 IE 的临床特征具有重要价值，并为我国地区的临床决策提供参考。
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