北医心内膜炎_赵锋.ppt

Libman-sacks 心内膜炎? 北大医院心内科 赵锋 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, Associations, 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 antiphospholipid 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. 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. 影像学技术必须与临床结合！ * * Am J Med. 2007;120(7):636-42 J Rheumatol. 2008 Feb;35(2):224-9. Epub 2007 Dec 15. *