| Objective: To explore the pathogenesis and clinical features of infective endocarditis(IE),and evaluate the clinical treatment effect and its influencing factors,we analyzed the clinical data of patients with IE.To provide clinical reference for the prevention and clinical diagnosis and treatment of IE.Methods: Clinical data of 216 patients with IE were collected.All patients with IE were inpatients who stayed in the First Affiliated Hospital Of Guangxi Medical University from January 2012 to December 2018.we analyzed the risk factors,blood culture,serological test,imaging data,treatment plan and outcomes of patients with IE.and evaluated the clinical treatment effect and its influencing factors.Result:(1)88.9% of patients with IE had underlying diseases,non-rheumatic heart disease was the most common(45.8%),followed by congenital heart disease(CHD)(28.2%),and rheumatic valvular heart disease(RHD)was only 14.8.%,11.1% of patients had no underlying heart disease.Subgroup analysis:(1)Among the 23 cases of non-adult IE,CHD was the most common(65.2%),followed by non-rheumatic valvular heart disease(30.4%).(2)In 99 cases of non-rheumatic valvular disease with IE,the most common is mitral valve disease(55.6%),especially mitral valve prolapsecombined with insufficiency,followed by aortic valve disease(26.3%).(3)No matter adult subgroup or non-adult subgroup,left-to-right shunt is the most common type in 61 cases of CHD with IE.But the proportion of bicuspid aortic valve with IE in adult subgroup(37.0%)is significantly higher than that in non-adult subgroup(6.7%).(2)26.9%(58/216)of IE patients have risk factors;The following is the ratio of each risk factor: 27 cases(46.6%)in cardiac surgery,12 cases(20.7%)in the history of intravenous drug abuse,10 cases(17.2%)in type 2 diabetes,3 cases(5.1%)in cancer,and 2 cases(3.4%)in coronary angiography,2 cases(3.4%)with immunosuppressive agents and 2 cases(3.4%)with hemodialysis.(3)84.7% of patients had fever symptoms,54.6% had cardiac dysfunction,15.7% had embolism,and most of them were single organ embolism(94.1%),25.0% had renal dysfunction,and 3.2% had acute renal failure.(4)52.8% of patients had WBC increase,42.8% moderate or higher anemia.(5)The positive rate of pathogenic bacteria was 44.1%,including 58.2%of streptococci,21.5% of staphylococcus,5.1% of enterococci,6.3% of fungi,and 8.9% of other bacteria.In IE patients without basic heart disease,The positive pathogenic bacteria include 44.4% of staphylococci,33.3% of streptococci,and 22.2% of the other bacteria.(6)Vegetations were found in83.4% of IE patients,The most common vegetation`s location was left side heart(75.8%),followed by the right heart(18.7%),and both sides(5.5%).The vegetations of IE patients with basic heart disease mainly occurred in mitral valve(40.1%)and aortic valve(33.3%),while non-basic heart disease mainly occurred in tricuspid valve(45.0%)and aortic valve(30.0%).(7)68.5% of IE patients had been administrated medical treatment including intravenous antibiotics,and 31.5% underwent combined medical and surgical treatment.(8)73.1% of patients were cured.The mortality was 4.2%(9/216).22.7% ofpatients decided to abandon therapy and discharged.Univariate regression analysis showed that surgical treatment and white blood cell count were associated with hospital mortality(all P<0.05).Conclusion:(1)Most patients with IE have basic heart disease,the most common is non-rheumatic valvular disease,especially mitral valve prolapse combined with insufficiency,CHD is most common in non-adult IE patients.(2)Cardiac surgery or intervention therapy is a major risk factor for IE.Intravenous drug use,cancer,diabetes,immunosuppressive agents,and hemodialysis should also be taken seriously.(3)Fever is the main symptom of IE,which can be associated with anemia,cardiac insufficiency,renal dysfunction and embolism etc.(4)The pathogenic bacteria spectrum is still mainly streptococcus,but staphylococcus is the main pathogen of IE patients without basic heart disease.(5)Echocardiography is still the main method for IE imaging diagnosis.The detection rate of vegetations is high,and the location of vegetations is related to heart disease.(6)The in-hospital cure rate of patients with IE is only 73.1%,and the curative effect needs to be improved.Early surgery may be beneficial to reduce the hospital mortality rate. |
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