感染性心内膜炎延迟诊断的影响因素研究

Factors affecting the delayed diagnosis of infective endocarditis

摘要:

目的 探讨感染性心内膜炎（IE）延迟诊断的影响因素。方法 回顾性分析2012年1月—2021年12月山西医科大学第一医院心胸外科收治的122例IE患者，将患者资料按已具备疑诊条件而是否被纳入IE诊断流程分为延迟诊断组和对照组，分别有49和73例。分析延迟诊断的临床影响因素。结果 两组患者性别、年龄比较，差异无统计学意义（P >0.05）。延迟诊断组住院天数长于对照组（P <0.05）。延迟诊断组发病到进入诊断流程天数、发病到确诊天数长于对照组（P <0.05）。两组患者进入诊断流程到确诊天数比较，差异无统计学意义（P >0.05）。延迟诊断组基础性心脏病、血管表现、免疫表现、其他血清学证据忽视比例高于对照组（P <0.05）。两组患者发热症状忽视比例比较，差异无统计学意义（P >0.05）。两组患者阳性率比较，差异无统计学意义（P >0.05）。两组患者使用抗生素血培养阳性率比较，差异有统计学意义（P <0.05）。两组患者超声心电图诊断准确率比较，差异有统计学意义（P <0.05）。结论 IE的临床表现呈现出多样化的特点，在鉴别诊断中应提高主要诊断标准对IE阳性的提示能力，并对容易忽略的次要诊断标准有足够的警觉，防止延迟诊断。

Abstract:

Objective To investigate the factors affecting the delayed diagnosis of infective endocarditis (IE).Methods A total of 122 patients with infective endocarditis (IE) admitted to the Department of Cardiothoracic Surgery in the First Hospital of Shanxi Medical University from January 2012 to December 2021 were reviewed. They were divided into a delayed diagnosis group (49 cases) and a control group (73 cases) based on whether they were included in the IE diagnosis process with the presence of evidence for suspected diagnosis. The clinical factors affecting the delayed diagnosis were analyzed.Results There was no difference in the sex composition and age between the two groups (P > 0.05). The length of hospital stay in the delayed diagnosis group was longer than that in the control group (P < 0.05). Compared with the control group, the time from onset to inclusion into the IE diagnosis process and the time from onset to confirmed diagnosis were longer in the delayed diagnosis group (P < 0.05). There was no difference in the time from inclusion into the IE diagnosis process to confirmed diagnosis between the two groups (P > 0.05). The proportions of cases with neglect of cardiac comorbidities, vascular and immunological manifestations, and other serological evidence in the delayed diagnosis group were higher than those in the control group (P < 0.05). There was no difference in the proportion of cases with neglect of fever between the two groups (P > 0.05). The positive rates of blood cultures were not different between the two groups (P > 0.05), while the positive rates of blood cultures after antibiotic use and the diagnostic accuracy via echocardiography were different between the two groups (P < 0.05).Conclusions The clinical manifestations of IE are diversified. Thus, the secondary criteria that are easily overlooked should be also highlighted in the differential diagnosis while focusing on the primary diagnostic criteria strongly indicative of IE, so as to prevent the delayed diagnosis.