Objective: To study the characteristics and misdiagnosis of infective endocarditis (IE). Methods: Clinical and pathological data of 15 IE patients diagnosed by autopsy were collected, compared with the cohort of 29 regular IE cases. Results: In the autopsy patients, IE in the left heart was predominat (14/15, 93.3%). Arterial embolism was the most common comorbidity (10/15, 66.7%), followed by pneumonia, malignancies, pyelonephritis (9/15, 60.0%; 7/15, 46.7%; 6/15, 40.0% respectively). The age was elder [(64.0±21.2)years vs(50.8±18.3)years, t=-2.15, P=0.037] in autopsy patients than in control group. More patients of missed diagnosis were combined with malignancies or deep vein catheterization [7/15(46.7%)vs 1/29(3.4%); 5/15(33.3%)vs 0/29(0)respectively]. Fever and cardiac murmur were rare in misdiagnosed cases[11/15(73.7%)vs 28/29(96.9%), 0/15(0)vs 15/29(51.7%) respectively]. Echocardiography and blood culture were performed in only 33.3%(5/15) and 26.7%(4/15) cases of missed diagnosis with low positive rates compared with regular IE patients [0/15(0) vs 27/29 (93.1%); 1/15(6.7%) vs 15/29(55.6%)]. Conclusions: Infective endocarditis should be suspected in patients with the risk factors of IE even without fever or cardiac murmur. Echocardiography and blood culture should be done as screening tests of IE.
目的： 总结临床漏诊感染性心内膜炎的特点，分析临床漏诊的原因。 方法： 回顾性分析1971—2016年北京医院临床漏诊感染性心内膜炎病例的尸检病理特点，对比分析临床漏诊病例(15例)与临床诊断病例(29例)之间临床表现的异同。 结果： 临床漏诊病例尸检发现左心系统感染性心内膜炎更为常见(14/15，93.3%)，动脉系统栓塞常见(10/15，66.7%)，多合并肺炎(9/15，60.0%)、恶性肿瘤(7/15，46.7%)或肾盂肾炎(6/15，40.0%)。与临床诊断病例相比，临床漏诊病例年龄更大[(64.0±21.2)岁比(50.8±18.3)岁，t＝－2.15，P＝0.037]、合并恶性肿瘤、深静脉置管比例更高[7/15(46.7%)比1/29(3.4%)和5/15(33.3%)比0/29(0)]，出现发热及新发的心脏杂音或原有心脏杂音变化的比例较低[11/15(73.7%)比28/29(96.9%)，0/15(0)比15/29(51.7%)]、行超声心动图及血培养的比例较低[5/15(33.3%)比27/29(93.1%)，4/15(26.7%)比27/29(93.1%)]，超声心动图及血培养的阳性率均较低[0/15(0)比27/29(93.1%)，1/15(6.7%)比15/29(55.6%)]。 结论： 对于感染性心内膜炎的高危人群出现栓塞、发热等事件时，即使缺乏心脏杂音等症状体征，亦应充分警惕感染性心内膜炎，及时规范的进行超声心动图及血培养检查是避免漏诊的关键。.
Keywords: Autopsy; Endocarditis, bacterial.