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Инфекционный эндокардит как причина развития дисфункции клапанов сердца

https://doi.org/10.18087/cardio.2019.3.10245

Полный текст:

Аннотация

Инфекционный эндокардит (ИЭ) – заболевание, сопровождающееся высокой госпитальной смертностью. Одним из основных осложнений ИЭ, требующих хирургического вмешательства, является дисфункция пораженных клапанов сердца – как нативных, так и протезных. В обзоре рассматриваются причины возникновения и течение ИЭ. В частности, рассмотрена роль сопутствующих инфекционных очагов в формировании и развитии ИЭ, описаны механизмы взаимного перехода подострой и острой клинических форм, современные принципы и методы диагностики на основе системы критериев Дьюка, а также сложности, которыми сопровождается оценка клинического статуса пациента. Подробно рассмотрены участие нормобиоты организма человека и возможности для их идентификации методом микробиологического посева и полимеразной цепной реакции. В соответствии с современными исследованиями сделан вывод о вкладе облигатно анаэробных бактерий, грибов и вирусов в развитие эндокардита. На основании анализа данных литературы представлены предположительные принципы формирования дисфункции клапанов сердца в результате метаболической активности клеток возбудителей ИЭ: к стенозу клапана может приводить вегетация, сформированная Staphylococcus aureus, а к регургитации – разрушение структуры клапана сердца под действием гиалуронидаз, коллагеназ; способность клеток возбудителей заболевания избегать ответной реакции иммунной системы человека обусловлена образованием биопленок, фибриновых вегетаций и выработкой целого ряда ферментов – цитотоксинов (стрептолизины, лейкоцидин и др.). Сделано предположение об участии медиаторов воспаления и лейкоцитарных клеток в разрушении нативной и протезной тканей вследствие недоступности возбудителей ИЭ для иммунокомпетентных клеток.

Об авторах

В. В. Роголевич
ФГБНУ «НИИ комплексных проблем сердечно-сосудистых заболеваний», Кемерово
Россия
junior researcher at the Laboratory of Novel Biomaterials


Т. В. Глушкова
ФГБНУ «НИИ комплексных проблем сердечно-сосудистых заболеваний», Кемерово
Россия


А. В. Понасенко
ФГБНУ «НИИ комплексных проблем сердечно-сосудистых заболеваний», Кемерово
Россия


Е. А. Овчаренко
ФГБНУ «НИИ комплексных проблем сердечно-сосудистых заболеваний», Кемерово
Россия


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Для цитирования:


Роголевич В.В., Глушкова Т.В., Понасенко А.В., Овчаренко Е.А. Инфекционный эндокардит как причина развития дисфункции клапанов сердца. Кардиология. 2019;59(3):68-77. https://doi.org/10.18087/cardio.2019.3.10245

For citation:


Rogolevich V.V., Glushkova T.V., Ponasenko A.V., Ovcharenko E.A. Infective Endocarditis Causing Native and Prosthetic Heart Valve Dysfunction. Kardiologiia. 2019;59(3):68-77. (In Russ.) https://doi.org/10.18087/cardio.2019.3.10245

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