心内膜炎赵锋
16页1、Libman-sacks 心内膜炎?,病史,女性,17岁,SLE病史 入院前1月病情加重,在当地激素治疗效不佳,因急进性肾炎,住肾内科 入院后的病情: 发热 急性肾功能衰竭 狼疮脑病 ANA+, anti-dsDNA+, anti-PL+, ANCA-,无心脏杂音,但,诊断是什么?,感染性心内膜炎? Libman-sacks心内膜炎? 血培养的重要地位,临床决断,Libman-sacks心内膜炎可能性大 治疗: 激素冲击治疗免疫抑制剂 血液透析 抗生素,临床转归,SLE被控制 肾功能恢复,脱离了血透 血培养始终阴性 多次复查超声心动图无动态改变 出院后在当地随诊病情稳定,Libman-Sacks心内膜炎,于1924年命名 亦称“疣状心内膜炎(verrucous endocarditis)” 见于SLE,在anti-PL+者中更为常见 非感染性赘生物。左心瓣膜常见,一般附着在瓣叶的左室面,多呈扁平的疣装。主要成分为纤维素和血小板,可造成栓塞 在菌血症等情况下,易转成感染性赘生物,Libman-Sacks Endocarditis in SLE: Prevalence, Associati
2、ons, and Evolution,Libman-Sacks endocarditis was found in 38 pts (11%) among 342 consecutive pts In 24 of 38 pts, MV involvement was found, resulting in regurgitation in all, whereas stenosis co-occurred with regurgitation in 9 patients 13 (34%) of 38 pts had AV involvement; 11 had regurgitation and 8 had stenosis A significant association was found between Libman-Sacks endocarditis and disease duration and activity, thromboses, stroke, thrombocytopenia, anticardiolipin antibodies, and antiphosp
3、holipid syndrome A progression of valve lesions may occur during long-term follow-up. Among the 213 pts without vegetations at the beginning, 8 developed new Libman-Sacks lesions.,Am J Med. 2007;120(7):636-42,TTE vs. TEE for detection of Libman-Sacks endocarditis: a randomized controlled study,CONCLUSION: TEE is superior to TTE for detection of Libman-Sacks endocarditis and should be considered either as complement to a nondiagnostic TTE or as the initial test in patients with SLE with suspected cardioembolism, acute or subacute Libman-Sacks endocarditis with moderate or worse valve dysfunction, or superimposed infective endocarditis.,J Rheumatol. 2008 Feb;35(2):224-9. Epub 2007 Dec 15.,影像学技术必须与临床结合!,Thank You,
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