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目的探讨真菌性心内膜炎(FE)的临床特点,以提高对FE的认识。方法分析我院确诊的6例FE的临床资料。结果①6例患者中,4例男性,病程15d~9个月;②3例患者存在心脏基础病,风湿性心脏病2例,先天性心脏病换瓣术后1例,另系统性红斑狼疮(SLE)2例;③易患因素:长期使用广谱抗生素(5例次)、糖皮质激素使用(3例次)、狼疮活动(2例次)、心脏手术、呼吸机相关性肺炎、真菌性皮炎等(各1例次);④主要临床表现为发热(6/6)、栓塞(5/6);超声心动图(UCG)检出瓣周漏及瓣周积脓1例、赘生物5例,并且所有赘生物最大直径均≥1.2cm;⑤6例患者共检出致病真菌7株,其中念珠菌最多(4株),另有毛霉、隐球菌及青霉(各1株);⑥2例SLE患者接受了单纯抗真菌药物治疗,1例好转,1例死亡;另4例患者均接受了手术和药物联合治疗,痊愈2例,复发后死亡2例;结论FE是严重的深部真菌感染之一,多数患者存在诱因及基础疾病,临床表现具有起病隐匿、病程长、赘生物体积大、栓塞发生率高等特点,早期诊断及内外科联合治疗有利于改善预后。
Objective To investigate the clinical features of fungal endocarditis (FE) to improve the understanding of FE. Methods The clinical data of 6 confirmed FE in our hospital were analyzed. Results ① Among the 6 patients, 4 were male and the course of disease was 15 days to 9 months. ② The 3 patients had cardiac basic diseases, 2 cases of rheumatic heart disease, 1 case of congenital heart disease after valve replacement and 1 case of systemic lupus erythematosus (SLE) ); 2 predisposing factors: long-term use of broad-spectrum antibiotics (5 times), glucocorticoid use (3 times), lupus activity (2 times), cardiac surgery, ventilator-associated pneumonia, fungal dermatitis (1 case each); ④ The main clinical manifestations were fever (6/6), embolism (5/6); echocardiogram (UCG) detected perivalvular leakage and pus in 1 case, neoplasms in 5 cases, and All the largest diameter of all the neoplasms were ≥1.2cm; ⑤6 patients were detected pathogenic fungi 7 strains, of which Candida most (4), and another Mucor, Cryptococcus and Penicillium (1 strain); ⑥ 2 cases of SLE The patient received simple antifungal therapy, 1 case improved, 1 case died; the other 4 cases received operation and drug combination therapy, 2 cases recovered and 2 cases died of recurrence; Conclusion FE is one of the severe deep fungal infections , The majority of patients with incentives and underlying diseases, clinical manifestations with occult onset, long duration, large neoplasm, embolization, high incidence of early diagnosis and internal and external Combination therapy will help to improve prognosis.