心脏超声对感染性心内膜炎诊断价值的再评价

发布时间：2019-03-28 11:53

【摘要】：目的:探讨心脏超声在感染性心内膜炎(IE)诊断中的应用价值。方法:入选2013-01至2015-06就诊于本中心初步诊断为心血管植入式电子装置(CIED)感染的患者共478例。其中,根据症状、常规血培养、心脏超声检查疑似IE者9例,进一步接受正电子发射计算机断层摄影术(PET-CT)检查,以明确诊断及分型。然后,根据诊断分别进行针对性治疗,随访一年,检验心脏超声检查对CIED患者IE诊断的准确性。结果:3例患者因心脏超声未发现赘生物而初步诊断为菌血症,但经PET-CT检查后最终诊断为IE。2例患者心脏超声提示瓣膜赘生物而初步诊断为IE,但经PET-CT检查后发现心腔内电极导线及瓣膜均未见赘生物,其中1例伴随血培养阳性,最终诊断为菌血症,另1例无感染征象者最终诊断为非感染患者。4例患者在电极导线拔除术后因心脏超声可见赘生物而初步诊断为IE,但PET-CT检查发现心腔内无感染征象,最终确定为"非感染性纤维残留组织"。根据最终诊断分别采取针对性治疗,随访至少1年,所有患者均未出现新增感染及感染复发。结论:心脏超声对心腔内赘生物的判定存在误差,尤其对于接受电极导线拔除术后的疑似IE患者,应结合其他检查方法进行确定诊断,制定正确的治疗策略。
[Abstract]:Objective: to evaluate the value of echocardiography in (IE) diagnosis of infective endocarditis. Methods: from January 2013 to June 2015, 478 patients with (CIED) infection of cardiovascular implantable electronic device were enrolled in the center. According to the symptoms, routine blood culture and echocardiography, 9 patients with suspected IE were further examined by positron emission computed tomography (PET-CT) in order to confirm the diagnosis and classification. Then, according to the diagnosis of targeted treatment, follow-up for one year, to test the accuracy of cardiac ultrasound in the diagnosis of CIED patients with IE. Results: three patients were initially diagnosed as bacteremia because no vegetations were found by echocardiography, but after PET-CT examination, the patients were diagnosed as valve vegetations in IE.2 patients, and the initial diagnosis was IE,. However, after PET-CT examination, no vegetations were found in the electrodes and valves in the cardiac cavity, one of them was positive with blood culture, and the final diagnosis was bacteremia. The other one with no sign of infection was diagnosed as non-infected. After electrode wire extraction, 4 patients were initially diagnosed as IE, because of the vegetations of cardiac ultrasound, but no signs of infection were found in the heart cavity by PET-CT, but no signs of infection were found in the heart cavity of 4 patients after electrode wire extraction. Finally identified as "non-infective fiber residue tissue". According to the final diagnosis, the patients were followed up for at least 1 year, and no new infection and recurrence were found in all patients. Conclusion: there are errors in the diagnosis of intracavitary vegetations by echocardiography, especially for patients with suspected IE after electrode wire extraction, the diagnosis should be made in combination with other methods, and the correct treatment strategy should be worked out. [WT5 "HZ] conclusion: [WT5" BZ] [WT5 "BZ]
【作者单位】：北京大学人民医院心脏中心;北京安贞医院;
【基金】：科技部国家科技支撑计划(2014BAI11B08)
【分类号】：R542.4

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