感染与心血管疾病.ppt

1、感染与心血管疾病,一、文献来源二、内容简介三、分析与讨论四、结论与启示,一、文献来源,1. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis 2010; 10: 83922.Influenza and Cardiovascular Disease：Is There a Causal Relationship? Tex Heart Inst J.2004;31(1): 413.3. Immunosuppressive Treatment for Inflammatory Cardio

2、myopathy. Int Heart J 2005; 46: 113-1224. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009). European Heart Journal (2009) 30, 23692413. 5. Efficacy of daptomycin in the treatment of enterococcal endocarditis: a 5 year comparison with conventional th

3、erapy. J Antimicrob Chemother.2014 Feb 13, PMID:24532682,1、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30 min1 h）后，应根据循证医学和相关指南尽早

4、、足量、经验性选用抗感染药物。,二、内容简介,三、分析与讨论,Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis 2010; 10: 8392,A Several mechanisms trigger the disruption of an advanced coronary lesion. The disrupted surface exposes underlying thrombogenic material. Plaque disruption alone is not s

5、ucient for the development of an acute coronary syndrome.,B Thrombogenic conditions (local and systemic) determine thrombus formation.,C The occlusive nature of the thrombus (total vs partial), the degree of stenosis, the presence of vasoconstriction, the coronary perfusion pressure, and the myocard

6、ial metabolic balance (demand vs supply) determine the evolution of an acute coronary syndrome.,2. Influenza and Cardiovascular Disease：Is There a Causal Relationship? Tex Heart Inst J.2004;31(1): 413.,TABLE II. Effects of Influenza on the Coagulation System,3. Immunosuppressive Treatment for Inflam

7、matory Cardiomyopathy. Int Heart J 2005; 46: 113-122,4.Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009). European Heart Journal (2009) 30, 23692413.,感染性心内膜炎的临床表现,感染性心内膜炎的诊断标准,5. Efficacy of daptomycin in the treatment of enterococcal endocarditis: a

8、 5 year comparison with conventional therapy. J Antimicrob Chemother.2014 ，13：PMID:24532682,Enterococcus spp. account for 10% of infective endocarditis (IE) Although daptomycin is a bactericidal drug with in vitro activity against Enterococcus, there is little experience of its use in IE. This was a

9、 retrospective descriptive study comparing the efcacy of daptomycin versus ampicillin/ ceftriaxone versus conventional antibiotic regimens (ampicillin or vancomycin+gentamicin) in EIE,Table 1. Baseline characteristics of the 32 patients with enterococcal infective endocarditis diagnosed during the study period,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BSAC指南，重症感染性心内膜炎起始经验治疗可启用万古霉素联合庆大霉素等。4、达托霉素单独治疗EIE，疗效并不优于上述传统治疗方案。,四、结论与启示,谢谢,Department of Macromolecular Science - Fudan University,