二尖瓣脱垂与感染性心内膜炎患者14例的临床分析及文献复习

目的 分析二尖瓣脱垂患者中感染性心内膜炎的临床和超声心动图特点,并复习总结相关文献资料.方法 该院1988年2月～2010年10月收住MVP合并IE的患者14例,回顾分析其临床资料.结果 MVP患者均有发热、心尖部3～4级收缩期杂音.4例(28.60％)有Osler结或肢端皮下出血,5例(35.70％)有大动脉栓塞表现.50.00％患者中性比例增高；12例(85.70％)患者红细胞沉降率增快,平均49.4 mm/h.大多患者有不同程度贫血.血培养阳性者9例,占64.00％,链球菌属占血培养阳性的89.0％.二尖瓣前叶脱垂者7例(50.00％),后叶脱垂者6例(42.90％),前后叶均脱垂者1例(7.10％).由经胸超声心动图或经食管超声心动图探查发现二尖瓣前叶有赘生物者4例(28.6％),后叶有赘生物者5例(35.7％),前后叶均有赘生物者1例(7.10％),单纯后叶脱垂前叶赘生物者2(14.30％)例,前叶脱垂合并左房赘生物者1例(7.10％).结论 MVP是IE的常见病因.IE临床特点为起病隐匿,诊断较困难,并发症的发生率较高.超声心动图检查对于诊断具有重要价值,经食管超声心动图检查对于发现瓣膜赘生物有较高敏感性.对于有感染性心内膜炎高危因素的二尖瓣脱垂者需要预防性应用抗生素.

Mitral valve prolapse and infective endocarditis: a clinical analysis of 14cases and literature review

【Objective】 To investigate the clinical characteristics,and echocardiographic characteristics of infective endocarditis(IE) in patients with mitral valve prolapse(MVP).【Methods】 Data of 14 patients with IE and MVP were analyzed retrospectively.【Results】 Osler nodules or acromelic subcutaneous hemorrhages were seen in 4(28.60%) cases,embolism in 5(35.70%) cases.50.00% of the cases had a higher percent of neutrophils and 85.70% of cases had an elevated ESR,with an average value of 49.4 mm/hr.Most of the cases had anemia.Positive culture was obtained in 64.00% of the cases.Posterior leaflet prolapse was found in 50.00% of the cases,anterior leaflet prolapse in 42.9% of the cases,and both leaflets prolapse was 7.1%.Vegetations were found in 28.60% of the posterior leaflets,35.70% of anterior leaflets,and 7.10% of both leaflets,and in atrium of one case.【Conclusions】 The diagnosis of IE was always difficult.The echocardiography was the method of choice for diagnosing mitral valve prolapse and IE.If patients had additional high risk features of prolapse,they should receive antibiotic prophylaxis.