静脉药瘾并HIV感染者感染性心内膜炎13例临床分析

目的 总结静脉药瘾并HIV感染者感染性心内膜炎(infective endoearditis,IE)的资料,提高对这种特殊类型IE的认识。方法 回顾性分析13例静脉药瘾并HIV感染者IE的临床资料。结果 男女比例为12:1,年龄27～39岁,无基础心脏疾病。主要临床表现为发热(100％,13/13)、心脏杂音(84.6％,11/13)、咳嗽、咳痰、气促(76.90A,10/13)。84.6％(11/13)的患者血象升高,61.5％(8/13)血培养阳性,以金黄色葡萄球菌最多见(5/8)。死亡病例的CD4 细胞计数明显降低。所有病例均合并肺部感染,痰培养以真菌最多见(7/12)。心电图表现以窦速合并ST-T改变多见。超声心动图显示三尖瓣受累最常见(92.3％,12/13),其次为二尖瓣(3/13),10例赘生物全部位于三尖瓣。结论 静脉药瘾并HIV感染者的IE以右心感染多见,发热、心脏杂音和血培养是诊断的重要依据,常合并肺部感染,超声心动图检查和T淋巴细胞分类对于判断预后有一定价值。

A clinical analysis of 13 infective endocarditis cases with HIV infection in intravenous drug users

Objective To study the clinical characteristics of infective endocarditis (IE) cases with HIV infection in intravenous drugs users, and to improve the recognition of this special type of IE. Methods Retrospective review of the clinical data was done in 13 IE cases with HIV infection in intravenous drug users. Results There were 12 male and 1 female whose age ranged from 27 to 39 years. None had cardiac underlying diseases. The main clinical manifestations included; fever ( 100% , 13/13 ), cardiac murmurs (84. 6% ,11/13) ,cough, expectoration and panting(76. 9% , 10/13) , and elevated WBC count (84. 6% , 11/13). The blood culture for bacteria was positive in 8 cases(61. 5% ) and staphylococcus aureus was most prevailent ( 5/8 ) . The CD4 counts in dead cases were decreased remarkably and all of cases had pulmonary infection with fungus (7/12) in most sputum culture. ECG manifested mainly tachycardia and ST-T changes. Ultrasonic cardiogram disclosed that tricuspid valve was easily involved (92. 3% ,12/13) , followed by mitral valve(3/13) , and all the 10 vegetations located in tricuspid valve. Conclusions IE with HIV infection in intravenous drug users occurred more in the right side of the heart. Fever, cardiac murmurs and positive blood culture were important in diagnosis and pulmonary infection often united. Ultrasonic cardiogram and T lymphocyte classification had certain value in judging prognosis.