libmansacks心内膜炎赵锋.pptxVIP

libmansacks心内膜炎赵锋会计学病史第1页/共16页女性，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，但第2页/共16页第3页/共16页第4页/共16页第5页/共16页第6页/共16页第7页/共16页诊断是什么？第8页/共16页感染性心内膜炎？Libman-sacks心内膜炎？血培养的重要地位临床决断第9页/共16页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第10页/共16页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心内膜炎第11页/共16页于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 第12页/共16页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 syndromeA 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):636-42TTE vs. TEE for detection of Libman-Sacks endocarditis: a randomized controlled study第13页/共16页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. 第14页/共16页影像学技术必须与临床结合！第15页/共16页Thank You