脊柱骨髓炎合并感染性心内膜炎。
Spondylodiscitis complicating infective endocarditis.
机构信息
Cardiology Department, APHM, La Timone Hospital, Marseille, France.
Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.
出版信息
Heart. 2020 Dec;106(24):1914-1918. doi: 10.1136/heartjnl-2019-316492. Epub 2020 May 28.
OBJECTIVE
The primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS.
METHODS
Prospective case-control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded.
RESULTS
Patients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without PS. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L4-L5. Neurological symptoms were observed in 59% of patients. Enterococci and were more frequent (24% vs 12% and 24% vs 11%; p<0001, respectively) in the PS group. The diagnosis of PS was based on contrast-enhanced MRI in 92 patients, bone CT in 88 patients and F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS.
CONCLUSIONS
PS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.
目的
本研究的主要目的是评估感染性心内膜炎（IE）患者合并化脓性脊柱骨髓炎（PS）的特征和预后。次要目的是评估与 PS 发生相关的因素。
方法
前瞻性、双中心病例对照研究纳入了 1755 例确诊的 IE 患者，其中 150 例（PS 组）患者合并 PS，1605 例（非 PS 组）患者未合并 PS。记录了临床、微生物学和预后相关变量。
结果
PS 组患者年龄较大（平均年龄 69.7±18 岁 vs 66.2±14 岁；p=0.004），且更多合并高血压（48% vs 34.5%；p<0.001）和自身免疫性疾病（5% vs 2%；p=0.03）。最常受累的是腰椎（84 例，66%），特别是 L4-L5。59%的患者存在神经系统症状。PS 组患者中更常分离出肠球菌和（24% vs 12%和 24% vs 11%；均 p<0.001）。92 例患者根据增强 MRI、88 例患者根据骨 CT、56 例患者根据 F-FDG PET/CT 诊断 PS。PS 组患者的院内（16% vs 13.5%；p=0.38）和 1 年死亡率（21% vs 22%；p=0.82）与非 PS 组患者无差异。
结论
PS 是 IE 的常见并发症（IE 中占 8.5%），见于合并肠球菌或链球菌 IE 的老年高血压患者，其预后与其他类型 IE 相似。由于 PS 与特定治疗相关，应采用 MRI、CT 和 PET/CT 等多种影像学方法进行早期诊断。
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