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感染性心内膜炎的当前诊断

Current diagnosis of infective endocarditis.

作者信息

Sawae Y

出版信息

Jpn Circ J. 1985 May;49(5):519-28. doi: 10.1253/jcj.49.519.

Abstract

An analysis was made of 91 cases of infective endocarditis (IE) with regard to causative organisms and their sensitivities to various antibiotics, the clinical features of the disease, the laboratory test results and other items were important in establishing a diagnosis of IE. The number of cases of IE has shown a tendency to increase in recent years, particularly in the number of elderly patients, and the ratio of total cases consisting of prosthetic valve endocarditis (PVE) has shown a sharp increase. The most common causative organism is still Streptococcus viridans, but there has been an increase in the incidence of IE due to benzyl-penicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis and other fastidious organisms. The percentage of underlying diseases represented by combined valvular diseases has been increasing, while the primary known cause of the infection of IE was dental treatments. A positive value for CRP, an accelerated value for ESR, leukocytosis, anemia, a decrease in serum Fe, a positive value for RA-T, were all parameters which showed a high correlation with IE, and these should be useful in establishing the diagnosis of IE. The use of cardioechography to detect cardiac vegetation is important in relation to establishing the diagnosis and prognosis of IE, and the evaluation of the therapeutic results.

摘要

对91例感染性心内膜炎(IE)患者进行了分析,涉及致病微生物及其对各种抗生素的敏感性,该疾病的临床特征、实验室检查结果以及其他项目对IE的诊断很重要。近年来,IE病例数呈上升趋势,尤其是老年患者数量增加,人工瓣膜心内膜炎(PVE)占总病例数的比例急剧上升。最常见的致病微生物仍然是草绿色链球菌,但耐苄青霉素的金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌和其他苛养菌导致的IE发病率有所增加。以联合瓣膜病为代表的基础疾病比例一直在上升,而IE感染的主要已知原因是牙科治疗。CRP阳性、ESR加快、白细胞增多、贫血、血清铁降低、RA-T阳性,这些参数均与IE高度相关,对IE的诊断有帮助。使用心脏超声心动图检测心脏赘生物对于IE的诊断、预后以及治疗效果评估都很重要。

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