Brain Embolic Event in Infective Endocarditis: Risk Factor Analysis

感染性心內膜炎患者併發腦栓塞之危險因子分析

鄭文君(Wen-Chun Cheng) ； 白培英(Pei-Ying Pai) ； 周湘台(Hsiang-Tai Chou)

《Mid-Taiwan Journal of Medicine》 10卷3期 (2005/03) Pp. 138-143

https://doi.org/10.6558/MTJM.2005.10(3).4

摘要

目的　栓塞的發生是感染性心內膜炎的併發症之一，且造成不良的生活品質，但在臺灣卻很少有關於超音波的診斷、臨床表現及栓塞預後的相關性研究，本研究主要是探討感染性心內膜炎患者併發腦栓塞的危險因子。
方法　收集了從1998 年1月至2002年12月發生感染性心內膜炎的病例，分析其年齡、性別、菌種、栓塞的發生、感染的瓣膜、贅生物大小、發炎指數和死亡率及相關性。
結果　此回溯性的研究，共收集93個病例，其中28人發生了栓塞。而發生栓塞的病例中有10人死亡，其中腦栓塞的發生率明顯較高，另外感染二尖瓣的心內膜炎及贅生物大於1公分者，其發生腦栓塞比例也明顯升高。
結論　腦栓塞是發生感染性心內膜炎死亡的重要因子，而感染二尖瓣的心內膜炎及贅生物大於1公分者，則為發生腦栓塞的危險因子。

關鍵字

腦栓塞 ； 感染性心內膜炎 ； 贅生物大小

並列摘要

Purpose Embolic events occur in 30% to 40% of patients with left-sided infective endocarditis. This study is designed to identify the relationship between embolic events, echocardiographic findings, clinical features and patient outcome.
Methods. In this retrospective study, we identified 93 patients with definite infective endocarditis from January 1998 to December 2002 according to modified Duke criteria. The relationships between age, sex, microorganism, major embolic events, involved valve, vegetation size, peak C-reactive protein and in-hospital death were analyzed.
Results. There were 93 patients with infective endocarditis, 28 had major embolic events. The major embolic events included brain emboli, spleen emboli, pulmonary emboli and kidney emboli. There were 8 patients with brain embolism in the non-fatal group (n=71) and 8 patients in the fatal group (n=22). The incidence of brain embolism was significantly higher in the fatal group (p=0.019). The risk factors of brain embolism were mitral valve involvement (p=0.003) and vegetation size greater than 1 cm in diameter. No significant difference in vegetation size was found between embolisms involving the mitral valve and aortic valves.
Conclusions. Brain embolism is a prognostic predictor of in-hospital mortality in patients with infective endocarditis. Patients are at higher risk of brain emboli in infective endocarditis with mitral valve involvement and vegetation size greater than 1 cm in diameter.

並列關鍵字

brain emboli ； infective endocarditis ； vegetation size