Tamura K
Division of Surgical Pathology, Nippon Medical School, Tokyo, Japan.
Kyobu Geka. 1996 Jul;49(8 Suppl):606-11.
Clinico-pathological studies were made of 40 patients with infective endocarditis : 34 (22 men, 12 women ; ages, 5-71 years, mean, 40.4 years) had native valve endocarditis (NVE) and 6 (3 men, 3 women ; ages, 26-48 years, mean, 38.3 years) had prosthetic valve endocarditis (PVE). The aortic valve was involved most frequently (AV : 16, MV : 6, AV+MV : 8, TV : 3, MV+TV : 1). Thirteen patients had preexsisting heart disease (rheumatic in 4, floppy in 6, other in 3). Six of 21 "normal" valves showed myxomatous changes with connective tissue degradation, findings compatible with the histological diagnosis of floppy valve. The infecting organisms were identified by blood cultures in 26 patients. Bacteria and/or fungi were found histologically in 23 valves, even in those in which cultures of excised tissues were negative. In 2 cases, fungi were identified in the sewing ring of the prosthetic valves. This study demonstrates that : 1) floppy valve is a most important underlying heart disease in NVE ; 2) the infecting organisms are frequently identified histologically, even when cultures of excised tissues are negative ; and 3) fungi are important causes of both NVE and PVE, especially in patients given intensive antibiotic therapy.
对40例感染性心内膜炎患者进行了临床病理研究：34例（22例男性，12例女性；年龄5 - 71岁，平均40.4岁）患有天然瓣膜心内膜炎（NVE），6例（3例男性，3例女性；年龄26 - 48岁，平均38.3岁）患有人工瓣膜心内膜炎（PVE）。主动脉瓣受累最为常见（主动脉瓣：16例，二尖瓣：6例，主动脉瓣 + 二尖瓣：8例，三尖瓣：3例，二尖瓣 + 三尖瓣：1例）。13例患者有先前存在的心脏病（4例为风湿性，6例为瓣膜脱垂，3例为其他）。21个“正常”瓣膜中有6个显示出黏液瘤样改变伴结缔组织退变，这些发现与瓣膜脱垂的组织学诊断相符。26例患者通过血培养鉴定出感染病原体。在23个瓣膜中组织学检查发现细菌和/或真菌，即使切除组织培养为阴性的瓣膜也是如此。在2例患者中，在人工瓣膜的缝合环中鉴定出真菌。本研究表明：1）瓣膜脱垂是NVE中最重要的潜在心脏病；2）即使切除组织培养为阴性，感染病原体也经常通过组织学鉴定出来；3）真菌是NVE和PVE的重要病因，尤其是在接受强化抗生素治疗的患者中。
