Hogevik H, Olaison L, Andersson R, Lindberg J, Alestig K
Department of Infectious Diseases, Göteborg University, Sweden.
Medicine (Baltimore). 1995 Nov;74(6):324-39. doi: 10.1097/00005792-199511000-00003.
A prospective study of the epidemiology of infective endocarditis (IE) in a well-defined urban population of 428,000 inhabitants during a 5-year period was carried out. All patients were treated in the same institution, and history, diagnostic procedures, and treatment were standardized. Of 233 consecutive suspected episodes of IE, 127 fulfilled the modified von Reyn criteria. After patients not living in the defined area were excluded, 99 episodes in 90 patients were analyzed in the epidemiologic part of the study. Of these, 33 episodes were definite endocarditis, verified by surgery or autopsy; 35 probable; and 31 possible endocarditis episodes. Another 34 episodes were found retrospectively and are included in the incidence calculation. The crude incidence was calculated to be 6.2/100,000 inhabitants per year, which is high compared to earlier studies. Adjusted to the population of Sweden, the incidence was 5.9/100,000 inhabitants per year. The annual incidence was higher for women, 6.6/100,000, than for men, 5.8/100,000. In the oldest age-group (80-89 years) the annual incidence was 22/100,000 in the prospective study and 30/100,000 if retrospective cases were included. Contrary to almost all other studies, we did not find a male predominance among our cases. Only 7% of patients were intravenous drug abusers, and 15% had a prosthetic valve. The most common bacteria were methicillin-susceptible Staphylococcus aureus (31%) and alpha-streptococci (28%); 12% of episodes were culture negative. The mortality from IE in the population was 1.4/100,000 inhabitants per year. A higher-than-expected incidence of IE was found, especially among older patients and women.
对一个有42.8万居民的明确界定的城市人口在5年期间感染性心内膜炎（IE）的流行病学进行了一项前瞻性研究。所有患者均在同一机构接受治疗，病史、诊断程序和治疗均实现标准化。在233例连续的疑似IE发作中，127例符合改良的冯·雷诺标准。在排除不住在规定区域的患者后，对研究流行病学部分的90例患者中的99次发作进行了分析。其中，33次发作经手术或尸检证实为确诊心内膜炎；35次为可能心内膜炎；31次为疑似心内膜炎发作。另外34次发作是回顾性发现的，并纳入发病率计算。粗发病率经计算为每年6.2/10万居民，与早期研究相比偏高。根据瑞典人口进行调整后，发病率为每年5.9/10万居民。女性的年发病率较高，为6.6/10万，高于男性的5.8/10万。在前瞻性研究中，最年长年龄组（80 - 89岁）的年发病率为22/10万，若纳入回顾性病例则为30/10万。与几乎所有其他研究相反，我们的病例中未发现男性占主导。仅7%的患者为静脉药物滥用者，15%有人工瓣膜。最常见的细菌是对甲氧西林敏感的金黄色葡萄球菌（31%）和α - 链球菌（28%）；12%的发作血培养阴性。该人群中IE的死亡率为每年1.4/10万居民。发现IE的发病率高于预期，尤其是在老年患者和女性中。
