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《国际心血管病杂志》[ISSN:1006-6977/CN:61-1281/TN]

期数:

2018年02期

页码:

112-116

栏目:

临床研究

出版日期:

2018-03-25

文章信息/Info

Title:

Clinical features of infective endocarditis with renal injury

作者:

张航; 虞敏; 施盛; 王利民; 沈锋; 袁忠祥

200080 上海,南京医科大学附属上海市第一人民医院心脏及大血管外科(张航,虞敏,袁忠祥); 200080 上海,上海交通大学附属第一人民医院心脏及大血管外科(施盛,王利民,沈锋)

Author(s):

ZHANG Hang¹;  YU Min¹;  SHI Sheng²;  WANG Limin²;  SHEN Feng²;  YUAN Zhongxiang¹.

1. Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical University, Shanghai 200080; 2. Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China

关键词:

感染性心内膜炎;  肾功能损伤;  病原菌;  心脏外科手术

Keywords:

Infective endocarditis;  Renal injury;  Pathogen;  Cardiac surgery

分类号:

-

DOI:

10.3969/j.issn.1673-6583.2018.02.013

文献标识码:

-

摘要:

目的:分析感染性心内膜炎(IE)合并肾功能损伤患者的临床特征、诊治和预后情况。方法:回顾性分析上海市第一人民医院2007年1月至2016年9月收治的126例IE患者的临床资料,其中1例行肾脏病理检查。以血肌酐(Scr)>133 μmol/L为肾功能损伤标准,将患者分为肾功能损伤组(n=25)和肾功能正常组(n=101),对两组的病原菌、临床特点、诊治和预后情况进行分析。结果:126例IE患者中,25例(19.8%)合并肾功能损伤。病原菌阳性率为60.7%,链球菌(47.3%)是最常见的致病菌。与肾功能正常组相比,肾功能损伤组患者链球菌感染率更高(P<0.05),心功能更差,血红蛋白降低更明显,尿蛋白阳性率更高(P均<0.01)。肾功能损伤组和肾功能正常组患者的手术方式、术后心功能情况、围术期死亡率及并发症发生率无统计学差异(P均>0.05),但肾功能损伤组的手术时间、升主动脉阻断时间、体外循环时间均长于肾功能正常组(P均<0.05)。随访期间,肾功能损伤组中22例患者术后肾功能恢复正常,17例心功能改善,无IE复发患者。结论:IE合并肾功能损伤较常见,链球菌感染可能会增加肾功能损伤的发生率,对于IE合并肾功能损伤患者,应积极寻找病原学依据,把握手术时机,以提高临床疗效。

Abstract:

Objective:To identify the clinical features, diagnosis, treatment and outcome of infective endocarditis(IE)associated with renal injury.Methods:One hundred and twenty-six cases of IE admitted to Shanghai General Hospital from January 2007 to September 2016 were reviewed. Clinical parameters were collected and analyzed. One case underwent renal biopsy and the pathologies were analyzed. Patients were divided into renal injury group(n=25)and normal group(n=101)according to the serum creatinine(Scr>133 μmol/L defined as renal injury). The pathogenic bacteria, clinical features, diagnoses, treatments and outcomes were compared between the two groups.Results:Twenty-five cases(19.8%)suffered from renal injury. Microbiologic positive rate was 60.7%. Streptococcus(47.3%)was the most common pathogenic bacteria. Compared with normal group, the renal injury group had more streptococcus infection(P<0.05), more NYHA Ⅲ/Ⅳ, lower hemoglobin and higher urine protein positive rate(all P<0.01). There was no significant difference in surgical options, postoperative cardiac function, perioperative mortality and incidence of complications between the two groups(all P>0.05), while the operation time, aortic clamp time and cardiopulmonary bypass time were all longer in renal injury group than those in normal group(all P<0.05). In renal injury group, the renal functions of 22 patients recovered, the cardiac functions of 17 patients were improved, and there was no recurrence of IE during follow-up.Conclusions:Renal injury is common in IE. Patients infected with streptococcus might be more susceptible to renal injury. For the patients of IE with renal injury, we should actively seek the basis of etiology and seize the time of operation to improve the clinical effect.

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备注/Memo

备注/Memo:

基金项目:国家自然科学基金(81300094)
通信作者:袁忠祥,Email:yuanzx828@163.com

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更新日期/Last Update: 2018-04-20