Kreuzpaintner G, Horstkotte D, Lösse B, Strohmeyer G
Medizinische Klinik und Poliklinik, Abteilungen für Gastroenterologie und Kardiologie, Heinrich-Heine-Universität Düsseldorf.
Z Gastroenterol. 1992 Jun;30(6):397-402.
Of 92 consecutive patients treated for proven native valve endocarditis three had ulcerative colitis and 2 Crohn's disease. All 5 patients developed severe complications; three had to undergo emergency valve replacement. With a prevalence of 64.1/10(5) cases of inflammatory bowel disease the calculated incidence (5/92) revealed a significant over-representation of inflammatory bowel disease among patients with proven endocarditis (p less than 5.08 x 10(-9)). Possible explanations may be the suppression of cellular immune defense by therapeutic interventions, high frequency of bacteremia caused by increased permeability of the damaged mucosa for bacteria and a higher incidence of diagnostic and therapeutic interventions in this patient population. Therefore, prophylaxis for bacterial endocarditis should be carefully considered before expected bacteremias in patients with highly active inflammatory bowel disease even in the absence of cardiac factors predisposing to bacterial endocarditis.
在连续接受治疗的92例确诊为天然瓣膜心内膜炎的患者中，有3例患有溃疡性结肠炎，2例患有克罗恩病。所有5例患者均出现严重并发症；3例不得不接受急诊瓣膜置换术。炎症性肠病的患病率为64.1/10⁵例，计算出的发病率（5/92）显示，在确诊的心内膜炎患者中，炎症性肠病的比例显著过高（p＜5.08×10⁻⁹）。可能的解释包括治疗干预对细胞免疫防御的抑制、受损黏膜对细菌通透性增加导致菌血症的高发生率，以及该患者群体中诊断和治疗干预的较高发生率。因此，即使在没有易患细菌性心内膜炎的心脏因素的情况下，对于炎症性肠病高度活跃的患者，在预期发生菌血症之前，也应仔细考虑预防细菌性心内膜炎。
