单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Libman-sacks 心内膜炎?,北大医院心内科 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-,无心脏杂音，,但,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,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,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,屡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,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,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 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,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 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.2021 Feb;35(2):224-9.Epub 2007 Dec 15.,影像学技术必须与临床结合！,Thank You,