Collins Jennifer A, Zhang Yang, Burke Allen P
From the Department of Pathology, University of Maryland Medical Center, Baltimore, United States.
From the Department of Pathology, University of Maryland Medical Center, Baltimore, United States.
Pathol Res Pract. 2014 Dec;210(12):997-1004. doi: 10.1016/j.prp.2014.04.024. Epub 2014 May 16.
There are few studies on the histologic findings in native infective endocarditis, especially regarding mimics of autoimmune valvulitis.
We prospectively studied 106 surgical specimens from 95 patients with a clinical diagnosis of infective endocarditis on native valves, and compared gross and histologic findings with culture results, underlying valve disease, risk factors and time interval from symptom onset to surgical intervention.
There were 41 (39%) aortic, 33 (31%) mitral, 9 (9%) tricuspid, 1(.9%) pulmonic and 11 (10%) multiple valve replacements. Underlying valve disease was present in 26 (27%) patients (non-calcified bicuspid aortic valve, 10 (38%) cases; mitral valve prolapse, 5 (19%) cases; calcified trileaflet aortic valve, 5 (19%) cases; calcified bicuspid aortic valve, 2 (8%) cases; post-rheumatic mitral valve disease, 2 (8%) cases; hypertrophic cardiomyopathy-related mitral valve disease, 1 (4%) case, trileaflet aortic insufficiency 1 (4%) case) and associated with streptococcal infection (p = .001). Absence of underlying valve disease was associated with intravenous drug abuse (p = .01) and dialysis dependent renal disease (p = .006). Intravenous drug abuse was associated with staphylococcal infection (p = .03). Vegetations were present in 80 (75%) of cases, and on the nonflow surface of the valve in 65 (81%) of these. Gram-stain positivity and neutrophilic microabscesses were associated with staphylococcal infection (p = .03). Epithelioid macrophages with palisading features mimicking necrobiotic granulomas were seen in 42 (40%) valves and more frequently associated with streptococcal infection (p=.03). As expected, the presence of valve necrosis and acute inflammation decreased with an increase in time with respect to symptomatic onset.
Histologic findings that mimic autoimmune inflammation are frequent in infective endocarditis and associated with streptococcal infection. Risk factors for infective endocarditis include calcific valve disease.
关于原发性感染性心内膜炎的组织学表现的研究较少，尤其是关于自身免疫性瓣膜病的模仿情况。
我们前瞻性地研究了95例临床诊断为原发性瓣膜感染性心内膜炎患者的106份手术标本，并将大体和组织学表现与培养结果、潜在瓣膜疾病、危险因素以及从症状发作到手术干预的时间间隔进行了比较。
有41例（39%）主动脉瓣、33例（31%）二尖瓣、9例（9%）三尖瓣、1例（0.9%）肺动脉瓣和11例（10%）多瓣膜置换。26例（27%）患者存在潜在瓣膜疾病（非钙化二叶主动脉瓣，10例（38%）；二尖瓣脱垂，5例（19%）；钙化三叶主动脉瓣，5例（19%）；钙化二叶主动脉瓣，2例（8%）；风湿性二尖瓣病后，2例（8%）；肥厚型心肌病相关二尖瓣病，1例（4%）；三叶主动脉瓣关闭不全，1例（4%）），且与链球菌感染相关（p = 0.001）。无潜在瓣膜疾病与静脉药物滥用（p = 0.01）和依赖透析的肾病（p = 0.006）相关。静脉药物滥用与葡萄球菌感染相关（p = 0.03）。80例（75%）病例存在赘生物，其中65例（81%）位于瓣膜的非血流面。革兰氏染色阳性和中性粒细胞微脓肿与葡萄球菌感染相关（p = 0.03）。42个（40%）瓣膜中可见具有栅栏状特征的上皮样巨噬细胞，类似于坏死性肉芽肿，且更常与链球菌感染相关（p = 0.03）。正如预期的那样，瓣膜坏死和急性炎症的存在随着症状发作时间的增加而减少。
模仿自身免疫炎症的组织学表现在感染性心内膜炎中很常见，且与链球菌感染相关。感染性心内膜炎的危险因素包括钙化瓣膜病。
