（参考课件）感染与心血管疾病.ppt

感染与心血管疾病,1,一、文献来源二、内容简介三、分析与讨论四、结论与启示,2,一、文献来源,1.Roleofacuteinfectionintriggeringacutecoronarysyndromes.LancetInfectDis2010;10:83922.InfluenzaandCardiovascularDisease：IsThereaCausalRelationship?TexHeartInstJ.2004;31(1):413.3.ImmunosuppressiveTreatmentforInflammatoryCardiomyopathy.IntHeartJ2005;46:113-1224.Guidelinesontheprevention,diagnosis,andtreatmentofinfectiveendocarditis(newversion2009).EuropeanHeartJournal(2009)30,23692413.5.Efficacyofdaptomycininthetreatmentofenterococcalendocarditis:a5yearcomparisonwithconventionaltherapy.JAntimicrobChemother.2014Feb13,PMID:24532682,3,1、感染（infection）系指由细菌、病毒、真菌、衣原体、支原体、立克次体、螺旋体、原虫、蠕虫等病原体所致的疾病。各类病原体可引起多种类型的感染致心血管疾病，使患者健康严重受损和社会负荷沉重不堪。2、感染导致心血管疾病以感染性心包炎、感染性心肌炎和感染性心内膜炎较常见，而感染性心瓣膜病多由感染性心内膜炎引起，感染性血管炎较为少见。3、诊治：在尽快留取实验室检查标本（如疑诊感染性心内膜炎患者至少抽3次静脉血进行血培养，采血间隔30min1h）后，应根据循证医学和相关指南尽早、足量、经验性选用抗感染药物。,二、内容简介,4,三、分析与讨论,Roleofacuteinfectionintriggeringacutecoronarysyndromes.LancetInfectDis2010;10:8392,5,ASeveralmechanismstriggerthedisruptionofanadvancedcoronarylesion.Thedisruptedsurfaceexposesunderlyingthrombogenicmaterial.Plaquedisruptionaloneisnotsucientforthedevelopmentofanacutecoronarysyndrome.,BThrombogenicconditions(localandsystemic)determinethrombusformation.,CTheocclusivenatureofthethrombus(totalvspartial),thedegreeofstenosis,thepresenceofvasoconstriction,thecoronaryperfusionpressure,andthemyocardialmetabolicbalance(demandvssupply)determinetheevolutionofanacutecoronarysyndrome.,6,2.InfluenzaandCardiovascularDisease：IsThereaCausalRelationship?TexHeartInstJ.2004;31(1):413.,7,TABLEII.EffectsofInfluenzaontheCoagulationSystem,8,3.ImmunosuppressiveTreatmentforInflammatoryCardiomyopathy.IntHeartJ2005;46:113-122,9,10,11,4.Guidelinesontheprevention,diagnosis,andtreatmentofinfectiveendocarditis(newversion2009).EuropeanHeartJournal(2009)30,23692413.,12,感染性心内膜炎的临床表现,13,感染性心内膜炎的诊断标准,14,15,5.Efficacyofdaptomycininthetreatmentofenterococcalendocarditis:a5yearcomparisonwithconventionaltherapy.JAntimicrobChemother.2014，13：PMID:24532682,Enterococcusspp.accountfor10%ofinfectiveendocarditis(IE)AlthoughdaptomycinisabactericidaldrugwithinvitroactivityagainstEnterococcus,thereislittleexperienceofitsuseinIE.Thiswasaretrospectivedescriptivestudycomparingtheefcacyofdaptomycinversusampicillin/ceftriaxoneversusconventionalantibioticregimens(ampicillinorvancomycin+gentamicin)inEIE,16,Table1.Baselinecharacteristicsofthe32patientswithenterococcalinfectiveendocarditisdiagnosedduringthestudyperiod,17,18,1、感染引起心血管疾病的确诊比较困难，并且往往较晚，起始经验治疗对患者预后有着重要意义。2、病毒性心肌炎以对症支持治疗为主。虽然免疫参与了病程进展，但是抑制免疫的药物并不能改善患者的预后。3、根据ESC及