血液透析患者合并感染性心内膜炎6例临床分析

目的总结血液透析（hemodialysis,HD）患者合并感染性心内膜炎（infective endocarditis,IE）的临床特点及转归。方法回顾性分析1985年3月至2012年8月在广东省人民医院住院的6例HD合并IE患者的临床资料及随访结果。6例患者均符合IE改良的Duke诊断标准。结果入选患者6例,男1例,女5例,年龄52.8（42～68）岁;血液透析血管通路：5例自体动静脉内瘘、1例临时颈内静脉透析导管。主要临床表现及并发症：发热5例,心力衰竭恶化3例,脑栓塞3例。血培养阳性3例：2例粪肠球菌,1例光滑球拟酵母菌。超声心动图发现瓣膜赘生物5例,瓣膜穿孔1例,其中累及二尖瓣4例。3例病情恶化自动出院后1周内死亡,1例出院后4个月猝死,1例出院后17个月猝死,1例出院后4年至今仍存活。结论 IE合并HD患者在广东省人民医院尚属少见,患者易出现心力衰竭及栓塞等并发症,预后较差。

Clinical analysis of 6 cases with infective endocarditis in hemodialysis

Objectives To describe the clinical characteristics and outcomes of infective endocarditis （IE） in hemodialysis （HD） patients. Methods Clinical data of 6 HD patients complicated with IE in Guangdong General Hospital from March 1985 to August 2012 were retrospectively analyzed. All patients met modified Duke criteria for definite IE. Results The average age of the 6 patients was 52.8 years old （range： 46-68 years）. Five were females. Vascular accesses at the onset of IE were as follows ： arteriovenous fistula in 5 cases and temporary internal jugular vein catheter in 1 case. The common clinical manifestations and complications included fever in 5 patients, congestive heart failure in 3 patients and cerebral embolism in 3 patients. Blood culture was positive in 3 cases; Causative organisms included enterococcus in 2 cases and torulopsis yeast in 1 case. Echocardiography found vegetations in 5 cases and valve perforation in 1 case, involving mitral valves in 4 cases. Three cases were discharged automatically for aggravation and died in one week. Two cases were sudden death at 4 or 17 months after discharge respectively. One patient survived for more than 4 years. Conclusions HE patients complicated with IE in our center are rare. Complications such as heart failure and thrombosis are frequent, and the prognosis is poor.