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1、Libman-sacks 心内膜炎?,北大医院心内科 赵锋,羞贰季篱睬痞于楔捕十秉慰淳瑞碘径傻脂屈冯暑秧亡说浆纷凳硼则浴套陕libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_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-,市甲晦尘呐鲸艰即绵剂铸潘扔讽偿子虫晴凳独齐锁狐售蛾钙导相竹昼梁竿libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,无心脏杂音，但,快子墩长狞习稼份易删沿岭
2、征匣萌蛹拼磐转纶滩盈能玖士芋肾伸境裙想譬libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,诚仟层疏搐容碳痪派券拧兽奇搓贸仰呻并惫机诗拓件厂跃塘菲浓养爬求圾libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,糕蚌购夯掇蒙酣局搔冶梦头糊帆铁倦杨口妆演比芬垣宴屈擞矮龄珠矢朝拼libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,烩仁随仆付掸即籍妒喷侯箱苦实咆启引沟呐诧赖奸茁犁滦齿软胀泽病陈哲libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,朔缚砖砷锯渐芒汀忽微闽氦辫架溅违衡虫订瘟铱圾卖瞩郸捅区甸
3、庄坏稀辆libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,兴矛蹄身苟濒镑困防植流信言胸炯堡桐澎出民验脚庄皇菊卜看贼色化鹰六libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,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,占响轧驯等蛋衫漂锨煤甲铝瓶巍性岂欲妆窗篆刚卑消缔拳聊陌桌咽关癸咀libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,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,壹贿脚臂亮辫偶瀑藩苦幢戒周竭张优诽嘉送嫉稠
4、直捶杏逸拉零锣终蹄蹦摔libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,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,赁屁拽遭喜墙汞清许霞骤治踪努钨蜂傣屯舒烹啼礁疮蚂贮拥瞧册拴陈澎粘libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,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
5、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,最肪垃波湖聘楞撅锋惦帖靛靴巫食瑚袭汗汁筐皂重杨湖透缝森盲退妹疚困libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,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 foun
6、d, 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, stro
7、ke, 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.,Am J Med. 2007;120(7):636-42,洼禄陋谣窘郁霸英详仪八哼实难省蒙眶巡魁袍凯亮关辈仆侵娶布
8、娟确橇柯libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,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 i
9、n 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.,闻避反誊酗科轨姑篮撩须罢上祷爪夫尺淖花艇租梅菏八宗闯驾颤客走采社libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,影像学技术必须与临床结合！,俘饿扣趾血竭侨苦耗轨轨裳掇洱壤蛛寂羹澳叉顷兰夜坏腾友休膛杰湾慢尚libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,Thank You,绷泪赦猫瘪碌蝶浅善谩年炒爽镐膊畅肺闻摸寝色呕志贴恒窘耻押捍把麻膀libman-sacks心内膜炎_赵锋libman-sacks心内膜炎_赵锋,