坦桑尼亚国家心脏研究所慢性风湿性二尖瓣狭窄的组织病理学评估：与临床表现、发病机制和治疗的关系。
Histopathological evaluation of chronic rheumatic mitral valve stenosis: the association with clinical presentation, pathogenesis, and management at a National Cardiac Institute, Tanzania.
机构信息
School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Histopathology and Morbid Anatomy, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
出版信息
Cardiovasc Pathol. 2022 Sep-Oct;60:107434. doi: 10.1016/j.carpath.2022.107434. Epub 2022 May 15.
AIMS
The histopathology of mitral valve (MV) tissues have been reported in necropsy and retrospective studies. We prospectively studied the histopathological changes in rheumatic mitral stenosis using advanced techniques and corroborated these with clinical presentation, pathogenesis, and management.
METHODS
From January 2020 to February 2021, surgically excised rheumatic stenotic MV from 54 Tanzanian patients were studied. These were examined using hematoxylin-eosin, von Kossa staining, and immunohistochemistry.
RESULTS
The median (range) age of patients was 39 (14-57) years with 34 (63%) females. Secondary prophylaxis was given to 7 (13%) patients and 2 (3.7%) had evidence of rheumatic fever (RF). With hematoxylin-eosin, 37 (68.5%) specimens showed fibrinoid degeneration (FD), 44 (81.5%) leucocytic infiltrates, 6 (11.1%) Aschoff nodules, 30 (55.6%) calcification, and 39 (72.2%) fibrosis. Thirty-five (64.8%) specimens were positive to von Kossa. The proportion of specimens positive for CD3, CD20, CD68, and CD8 were 46 (85.2%), 35 (64.8%), 39 (72.2%), and 8 (14.8%) respectively. Valvular calcium was high among older patients, males and with a higher trans-MV gradient. The degree of inflammatory cellular infiltration was associated with valvular calcification, FD with ARF, leucocytic infiltrates with disease duration of <10 years, and fibrosis with the absence of atrial fibrillation. C-reactive protein and anti-streptolysin titres were high in CD20 and CD8 staining cells.
CONCLUSION
This study confirms that high MV calcium are found in patients who are old, male, and with severe mitral stenosis. The association between clinical parameters with histopathological-immunohistochemical studies observed in our study provides new insight to disease presentation. We found a low rate of secondary prophylaxis and two patients with ARF. Our findings are comparable with those from other countries suggesting similar pathogenesis and thus intervention modalities. This is the first study on mitral valve histopathology to be reported from Africa.
目的
已有尸检和回顾性研究报道了二尖瓣（MV）组织的组织病理学。我们前瞻性地研究了风湿性二尖瓣狭窄的组织病理学变化，使用了先进的技术，并将这些结果与临床表现、发病机制和治疗进行了印证。
方法
2020 年 1 月至 2021 年 2 月，我们研究了 54 例坦桑尼亚风湿性狭窄患者的手术切除的风湿性狭窄 MV。这些组织使用苏木精-伊红、von Kossa 染色和免疫组织化学进行了检查。
结果
患者的中位（范围）年龄为 39（14-57）岁，其中 34 例（63%）为女性。7 例（13%）患者接受了二级预防，2 例（3.7%）有风湿热（RF）的证据。苏木精-伊红染色显示，37 例（68.5%）标本显示纤维蛋白样变性（FD），44 例（81.5%）有白细胞浸润，6 例（11.1%）有阿绍夫结节，30 例（55.6%）有钙化，39 例（72.2%）有纤维化。35 例（64.8%）标本 von Kossa 染色阳性。CD3、CD20、CD68 和 CD8 阳性的标本比例分别为 46（85.2%）、35（64.8%）、39（72.2%）和 8（14.8%）。老年患者、男性和跨 MV 梯度较高的患者，MV 钙含量较高。炎症细胞浸润程度与瓣膜钙化有关，FD 与 ARF 有关，白细胞浸润与病程<10 年有关，纤维化与无房颤有关。CD20 和 CD8 染色细胞中的 C 反应蛋白和抗链球菌溶血素滴度较高。
结论
本研究证实，在年龄较大、男性和重度二尖瓣狭窄的患者中发现 MV 钙含量较高。我们的研究中观察到的临床参数与组织病理学-免疫组织化学研究之间的关联为疾病表现提供了新的见解。我们发现二级预防率较低，有两名患者患有 ARF。我们的发现与其他国家的发现相似，表明存在相似的发病机制和干预方式。这是非洲首例关于二尖瓣组织病理学的研究。
Zotero 插件