libmansacks心內(nèi)膜炎趙鋒

1、病史 女性，17歲，SLE病史 入院前1月病情加重，在當(dāng)?shù)丶に刂委熜Р患?，因急進(jìn)性腎炎，住腎內(nèi)科 入院后的病情： 發(fā)熱 急性腎功能衰竭 狼瘡腦病 ANA+, anti-dsDNA+, anti-PL+, ANCA-無心臟雜音，但診斷是什么？ 感染性心內(nèi)膜炎？ Libman-sacks心內(nèi)膜炎？ 血培養(yǎng)的重要地位臨床決斷 Libman-sacks心內(nèi)膜炎可能性大 治療： 激素沖擊治療免疫抑制劑 血液透析 抗生素臨床轉(zhuǎn)歸 SLE被控制 腎功能恢復(fù)，脫離了血透 血培養(yǎng)始終陰性 多次復(fù)查超聲心動圖無動態(tài)改變 出院后在當(dāng)?shù)仉S診病情穩(wěn)定Libman-Sacks心內(nèi)膜炎 于1924年命名 亦稱“疣狀心內(nèi)膜炎

2、(verrucous endocarditis)” 見于SLE，在anti-PL+者中更為常見 非感染性贅生物。左心瓣膜常見，一般附著在瓣葉的左室面，多呈扁平的疣裝。主要成分為纖維素和血小板，可造成栓塞 在菌血癥等情況下，易轉(zhuǎn)成感染性贅生物 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 involve

3、ment 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, thr

4、omboses, 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 end

5、ocarditis: 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 endoca

6、rditis with moderate or worse valve dysfunction, or superimposed infective endocarditis.影像學(xué)技術(shù)必須與臨床結(jié)合！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, resu

7、lting 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 durin