| Objective: to summarize clinical characteristic,echocardiography, pathogen,therapy and prognostic factors of infective endocarditis by analyzing clinical data,improve thediagnosis and treatment. Methods: to retrospectively analysis the clinical symptoms, blood culture, echocardiography and treatments and prognoses in 266 cases of IE from January 2002 to December 2013, the affiliated hospital of Luzhou Medical College-- the First People’s Hospital of Yibin and the Second People’s Hospital of Yibin,to compare the differences of blood culture, echocardiography, treatment and prognosis between patients with a history of the heart disease and without a history of heart disease in IE. Prognostic facters associated with IE determinded by univariate and multivariate regression analysis. Results: 1. There were 167 men and 99 wome with age of(39.6 ± 15.28) years, and the male-female ratio was 1.69:1. Their Ages varied from 11 to 72. 2. Among the 266 cases, 254 cases( 95.5%) were the antilogous valves, and 12 cases( 4.5%) the artificial valves.3. Sixty-nine(25.9%)of them had heart diseases,including 35 cases(13.2%)of rheumatic heart diseases and 27 cases(10.1%) of congenital heart diseases, among which the patent ductus arteriosus was most common, followed by ventricular septal defect, 7 cases(2.6%) ofrheumatic heart valve disease. 4. There were 22 cases(8.3%) with a history of heart surgeries, including 12 cases(4.5%) of artificial valve replacements, 1 case(0.4%) of coronary artery bypass surgeries, and 5 cases(1.9%) of congenital heart disease interventions and surgical treatments. 5. The clinical manifestations included fever, anemia, heart murmur, dyspnea and cough. Among the main performances, fever took up 176 cases(66.2%), anemia 84 cases(31.6%), heart murmur 102 cases(38.3%), dyspnea150 cases(56.4%), and cough 104 cases(39.1%). 6. Vegetations was found in 209 cases(78.6%), including 62 cases(23.3%) of mitral valve vegetations, 33 cases(12.4%) of tricuspid vegetations, 111 cases(41.7%) of aortic valve vegetations. In the highest proportion of aortic valve, 173 cases(65.0%) were left--heart, 36 cases(13.5%) right heart, 9 cases(3.4%) left and right heart. 7. 35.7% of blood cultures were positive, streptococcus for 34 cases(12.8%), staphylococcus for 38 cases(14.3%), fungus for 10 cases(3.8%), and other types for 13 cases(4.9%), among which streptococcus and staphylococcus were still the main pathogenic bacterias. 8. 72.9% had been administrated medical treatment including antimicrobial primarily, whereas 27.1% under combined medical and surgical treatment. 9. 64.3% of patients were cured. In these cases, 16 cases(6.0%) turned to the superior hospital; 56 cases(21.1%) discharged out of personal willingness; 23 cases(8.6%) died during hospitalization. Besides, the single factor regression analysisshowed that the factors leading to death in IE became from the manual valve, embolism, and heart failure. However, the surgical treatments made contribution to the protective factors. Moreover, the multiple factors regression illustrated that valve type( OR=14.45,95%CI 2.65-78.93, P=0.002),embolism( OR=20.41,95%CI 6.02-69.24,P=0.000) and heart failure(OR=6,763,95%CI1.68-27.23,P=0.007) were related to the increased risk of mortality inpatients with IE,while surgery(OR=0.048,95%CI0.004-0.589,P=0.018) appeared to be a protective factor. 10. The patients’ s features with a history of heart disease in IE.(1). There were 32 cases from men, and 37 cases from women. The proportion of male patients was up to 46.38%, which was lower than that 68.53%(P < 0.05) without fundamental heart disease in IE. Among the mean age(38.78 ± 10.21 years), the proportion of patients’ age at 50 or less was 66.7%, which didn’t observe obvious difference compared with the 72.9% without suffering from a basic heart disease in IE in which the patients’ age was the same(P > 0.05).(2) patients with a history of heart disease in IE considerably suffered from more anemia and heart murmur compared with ones without that(P < 0.05), but both of them did not present no obvious difference in fever and breathing difficulty(P > 0.05).(3) through the analysis of echocardiography between the ones with a history of heart disease and the ones without it in IE, the proportions of neoplasm and aortic vegetations decreasedsignificantly(P < 0.05), but the two cases’ cardiac dilatation didn’t differed tremendously(P > 0.05).(4) The positive rate of the blood culture and that of staphylococcus for patients with a heart disease increased significantly, contrary to ones without it in IE(P < 0.05).(5) The available proportion of surgical therapies for patients with an original IE history of heart disease soared obviously, compared with ones without it(P < 0.05). But, their ratios of improvements in the clinical and mortality shared no significant difference(P > 0.05). Conclusions: 1. The proportion of IE patients with an underlying history of heart reduced, while that of ones without it was on the rise. Besides, the congenital heart disease ratio increased and the rheumatic heart disease ratio decreased, but it still held the highest peak. Moreover, the users of the cardiac interventional therapy and intravenous drug become the new IE patients in risk factors. 2. The clinical manifestations of patients with IE were in diversity and most of them were not typical. Among those performances, fever was still the most common clinical symptom of IE, accompanied by anemia, breathing difficulties, heart murmur, embolism, etc., but the skin damage is rare. 3. The blood culture and echocardiography were still the most main diagnostic methods. IE echocardiography ratio was higher than that of blood culture, while both were remained to improve the positive rate. 4. The Streptococcus and staphylococcus is still the main pathogenic microorganisms for patientswith IE, in which the staphylococcus went on a rising trend and streptococcus proportion reduced. At the same time, more attention should be fixed on some other rare pathogenic bacteria, such as fungus, Q heat pathogens, HACEK, etc. 5. Antibiotic treatments were the essential treatment of IE, but for the poor medical treatment effect, the active surgical treatment still should be needed. 6. The hospital mortality was 8.6%, but the automatic discharge rate was as high as 21.1%, and the clinical improvement rate reached 64%. Some patients who discharged from hospital out of their willings enjoyed poor treatment effect, or some economic reasons forced them to give up treatments, which increased the poor prognoses. 7. The timely surgical treatments could obviously do good to the prognoses for the patients suffering from endocarditis, refractory heart failure, valvular perforation, however, the key is to grasp the operation indication and surgical timing. 8. The male proportion with a heart disease significantly reduced, compared to that without the IE history of heart disease; the incidence of anemia and heart murmur significantly got higher; the mitral valve were most common in ultrasonic vegetations; the aortic valve vegetations to a great extent reduced; the positive rate of blood culture soared considerably; the pathogenic bacterias are given priority to the staphylococcus; the treatments included the medical and surgical therapy, and surgical one become on the rise; its prognosis stated no obvious difference to these cases with a history ofheart disease. 9. The advancements of recognition of IE were the key to reduce misdiagnoses and improve the curative ratio. |
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