Heart:复发性感染性心内膜炎的流行病学特征和预后

2019-10-04 xing.T MedSci原创

由此可见,复发性IE仍是常见的晚期并发症。IVDU与再感染的风险增加了四倍有关,药物治疗的PVE和金黄色葡萄球菌引起的感染增加了复发的风险,但各组的院内和长期死亡率相当。

复发性感染性心内膜炎(IE)是首次IE患者的主要并发症。近日,心脏病领域权威杂志Heart上发表了一篇研究文章,这项研究旨在通过当代一个大型队列分析IE的复发现状。

从1996年至2015年,研究人员在西班牙的三个三级医疗中心招募了1335例连续就诊的IE患者进行了一项前瞻性研究。这些患者的IE发作被分类为I组(n=1227),首次IE发作和II组(n=108),复发性IE(8.1%)。在排除六名患者后,由于缺乏相关数据,II组被细分为IIa组(n=87),再感染(不同的微生物)和IIb组(n=15),复发(首次发作后6个月内相同的微生物)。

在研究的20年(2006-2015年)中,IE复发累积的负担和发生率略有降低(分别为7.17 vs. 4.10次事件/100名幸存者和7.51% vs. 3.82次事件/100名幸存者)。与I组相比,再感染患者明显年轻,HIV感染频率更高,更常见的是静脉吸毒(IVDU)和人工瓣膜携带者,栓塞并发症和心脏手术更少,院内死亡率相似。研究人员发现IVDU是再感染的独立预测因子(HR为3.92,95%CI为1.86-8.28)。在IE复发组中,人工瓣膜心内膜炎(PVE)和瓣膜周围并发症更为常见。在接受药物治疗的患者中,PVE患者的复发率较高(天然瓣膜IE患者为4.82% vs. 0.43%,p=0.018)。金黄色葡萄球菌和PVE是复发的独立预测因子(HR分别为3.14,95%CI为1.11-8.86和3.19,95%CI为1.13-9.00),院内死亡率与I组相似。IE复发组与单次发作组的三年全因死亡率相似。

由此可见,复发性IE仍是常见的晚期并发症。IVDU与再感染的风险增加了四倍有关,药物治疗的PVE和金黄色葡萄球菌引起的感染增加了复发的风险,但各组的院内和长期死亡率相当。 

原始出处:

Afonso B Freitas-Ferraz.et al.Contemporary epidemiology and outcomes in recurrent infective endocarditis.heart.2019.http://dx.doi.org/10.1136/heartjnl-2019-315433

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    2019-10-06 zhaojie88
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    2019-10-06 xugumin
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    2019-10-06 slcumt
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    2019-10-05 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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