Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
BMJ Open. 2020 Feb 12;10(2):e031512. doi: 10.1136/bmjopen-2019-031512.
This study aimed to characterise rheumatic manifestations and autoantibodies in 432 patients diagnosed with infective endocarditis (IE) in Shanghai.
DESIGN, SETTING AND PARTICIPANTS: A retrospective study was conducted in Ruijin Hospital from 1997 to 2017. The clinical and laboratory characteristics of a total of 432 patients were analysed. In addition, the differences between patients with positive and negative antineutrophil cytoplasmic antibodies (ANCA) and antiphospholipid (aPL) antibodies as well as the survival rates of these patients were compared.
A total of 432 patients, including 278 male patients and 154 female patients, were included. The mean age of the patients was 46±16 years. A total of 346 patients (80%) had cardiac surgery, and 55 patients (13%) died in the hospital. Among the IE patients, 104 were tested for either ANCA or aPL and were analysed in different groups. Twenty-one (24%) positive ANCA patients were proteinase 3-ANCA positive. Compared with the ANCA-negative group, patients with positive ANCA had higher IgM (p=0.048), lower haemoglobin (p=0.001) and a higher likelihood of arthritis (p=0.003). Twenty-one (40%) aPL-positive patients had a higher erythrocyte sedimentation rate than was found in the aPL-negative group (p=0.003). In addition, the survival rate of the ANCA-positive IE patients was lower (p=0.032) than that of the ANCA-negative group, while there was no difference between patients with or without aPL antibodies (p=0.728).
This study supports the claim that rheumatic manifestations and autoantibodies are frequently present in patients with IE and might lead to early misdiagnosis. Physicians should pay more attention to the measurement of autoantibodies in these patients.
本研究旨在描述上海 432 例感染性心内膜炎（IE）患者的风湿表现和自身抗体。
设计、地点和参与者：回顾性研究在 1997 年至 2017 年期间在瑞金医院进行。分析了总共 432 例患者的临床和实验室特征。此外，比较了抗中性粒细胞胞浆抗体（ANCA）和抗磷脂（aPL）抗体阳性和阴性患者之间的差异以及这些患者的生存率。
共纳入 432 例患者，其中男 278 例，女 154 例，平均年龄 46±16 岁。346 例（80%）患者行心脏手术，55 例（13%）患者院内死亡。在 IE 患者中，104 例患者检测了 ANCA 或 aPL，并在不同组中进行了分析。21 例（24%）阳性 ANCA 患者为蛋白酶 3-ANCA 阳性。与 ANCA 阴性组相比，阳性 ANCA 患者的 IgM 更高（p=0.048），血红蛋白更低（p=0.001），关节炎发生的可能性更高（p=0.003）。21 例（40%）aPL 阳性患者的红细胞沉降率高于 aPL 阴性组（p=0.003）。此外，阳性 ANCA IE 患者的生存率较低（p=0.032），而有无 aPL 抗体的患者之间无差异（p=0.728）。
本研究支持风湿表现和自身抗体在 IE 患者中经常出现并可能导致早期误诊的观点。医生应更加注意这些患者自身抗体的测量。
