老年感染性心内膜炎住院患者合并脑卒中临床分析

目的:探讨老年感染性心内膜炎(IE)患者脑卒中的发生规律。方法:回顾性分析北京安贞医院,近10年收治的年龄>60岁诊断为IE患者的临床资料。结果:共纳入63例患者,其中男性47例,女性16例,年龄在60~82岁,平均年龄(68.0±5.6)岁。包含5例人工心脏瓣膜心内膜炎,其余为自然瓣膜性心内膜炎。左侧心内膜炎57例,其余6例为右侧心内膜炎。62例患者(98.4%)经过彩色超声心动图或手术所见发现赘生物。23例患者合并脑卒中,占36.5%,3例为静止性脑梗死,20例患者为症状性脑卒中,其中症状性脑梗死15例,脑出血1例,蛛网膜下腔出血1例,另外3例患者因未行神经影像学检查无法定性。脑梗死主要分布于颈内动脉系统。脑卒中组二尖瓣赘生物发生率显著高于不伴脑卒中的患者(69.5%vs.40%,P=0.024),二尖瓣赘生物对脑卒中的(OR=3.429,95%CI:1.152~10.202)。合并脑卒中组病死率显著高于不伴有脑卒中的患者(21.7%vs.2.5%,P=0.012),脑卒中对于死亡的(OR=10.833,95%CI:1.178~99.595)。结论:在老年住院IE患者中,脑卒中发病常见。二尖瓣赘生物是脑卒中发生的危险因素,而脑卒中显著增加老年IE患者病死率。

The clinical analysis of stroke in elderly inpatients with infective endocarditis

Objective: To investigate the clinical characters of stroke in elderly patients with infective endocarditis( IE). Methods: A retrospective analysis of the data of patients( older than 60 years) with IE in Beijing Anzhen Hospital in recent 10 years. Results: 63 patients were enrolled,which include 47 males and 16 females,aged between 60 and 82 years,mean age( 68 ± 5. 6) years old. five cases with prosthetic valve endocarditis. Left-sided endocarditis in 57 patients,and right side endocarditis in six cases. Vegetations were found by color Doppler echocardiography or oroperation in 62( 98. 4%) cases. Twenty-three patients with stroke,three with silent cerebral infarction,20 patients with symptomatic stroke,including 15 cases with symptomatic cerebral infarction,1 patients with cerebral hemorrhage,1 cases with subarachnoid hemorrhage,and 3 patients undefined without neuroimaging examination. Cerebral infarction is mainly distributed in internal carotid artery system. The mitral valve vegetations incidence in stroke group was significantly higher than that that in patients without stroke( 69. 5% vs. 40%,P = 0. 024),stroke was associated with mitral valve vegetations( OR =3. 429,95% CI: 1. 152- 10. 202). The mortality in stroke group was significantly higher than that in patientswithout stroke( 21. 7% vs. 2. 5%,P = 0. 012),stroke was the risk factor of death in patients with IE( OR =10. 833,95% CI: 1. 178- 99. 595). Conclusion: Stroke is common in elderly inpatients with IE. The mitral valve vegetation is a risk factor for stroke,stroke increase the mortality of elderly inpatients with IE.