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目的:探讨心脏超声在感染性心内膜炎(IE)诊断中的应用价值。方法:入选2013-01至2015-06就诊于本中心初步诊断为心血管植入式电子装置(CIED)感染的患者共478例。其中,根据症状、常规血培养、心脏超声检查疑似IE者9例,进一步接受正电子发射计算机断层摄影术(PET-CT)检查,以明确诊断及分型。然后,根据诊断分别进行针对性治疗,随访一年,检验心脏超声检查对CIED患者IE诊断的准确性。结果:3例患者因心脏超声未发现赘生物而初步诊断为菌血症,但经PET-CT检查后最终诊断为IE。2例患者心脏超声提示瓣膜赘生物而初步诊断为IE,但经PET-CT检查后发现心腔内电极导线及瓣膜均未见赘生物,其中1例伴随血培养阳性,最终诊断为菌血症,另1例无感染征象者最终诊断为非感染患者。4例患者在电极导线拔除术后因心脏超声可见赘生物而初步诊断为IE,但PET-CT检查发现心腔内无感染征象,最终确定为“非感染性纤维残留组织”。根据最终诊断分别采取针对性治疗,随访至少1年,所有患者均未出现新增感染及感染复发。结论:心脏超声对心腔内赘生物的判定存在误差,尤其对于接受电极导线拔除术后的疑似IE患者,应结合其他检查方法进行确定诊断,制定正确的治疗策略。
Objective: To investigate the value of echocardiography in the diagnosis of infective endocarditis (IE). Methods: A total of 478 patients were enrolled in our center from 2013-01 to 2015-06 for initial diagnosis of ICED infection. Among them, according to the symptoms, conventional blood culture, echocardiographic examination of suspected IE in 9 cases, further accepted positron emission computed tomography (PET-CT) examination to confirm the diagnosis and classification. Then, according to the diagnosis were targeted treatment, follow-up of one year, test the diagnostic accuracy of echocardiography in patients with ICE. Results: Three patients were initially diagnosed as bacteremia because they did not find any neoplasms due to echocardiography, but the final diagnosis was IE after PET-CT examination. Two cases of echocardiography showed valvular vegetation and preliminary diagnosis of IE, but PET-CT examination found no extracapsular electrode and valve wire, of which 1 case with blood culture positive, the final diagnosis of bacteremia , Another case of infection-free signs of the final diagnosis of non-infected patients. Four patients were initially diagnosed with IE due to echocardiographic visualization of the neoplasm after removal of the lead. However, there was no sign of intracardiac infection in PET-CT, and the final result was “non-infectious residual tissue”. According to the final diagnosis were targeted treatment, followed up for at least 1 year, all patients did not appear new infections and infection recurrence. Conclusion: There are errors in the determination of intracardiac neoplasms by echocardiography. Especially for suspected IE patients who underwent lead extraction, definite diagnosis should be made according to other examination methods and the correct treatment strategy should be drawn.