风湿性心脏瓣膜病肝脏病理改变的临床意义

目的：探讨风湿性心脏瓣膜病（简称风心病）肝脏病理改变的临床意义。方法：选择风心病41例，其中合并三尖瓣关闭不全患30例，施行心脏瓣膜置换术，在体外循环建立前取肝组织活检，采用光学显微镜及H－800透视电镜检查。结果：风心病合并三尖瓣关闭不全，且有一定反流量患的肝脏典型病理改变主要表现为：（1）肝细胞间质改变：肝窦状隙淤血、扩张，肝纤维组织增生；（2）肝细胞改变：肝细胞肿胀，线粒体肿胀，嵴消失、肝细胞坏死。而且，本组患肝脏病理改变程度与三尖瓣反流量有关，反流量越大病理损伤越严重。结论：强调风心病合并三尖瓣关闭不全患应尽早手术，术中积极矫正三尖瓣关闭不全，是改善和恢复肝脏病理改变的重要措施。

Clinical significance of liver pathological changes in patients with rheumatic h eart valve disease

Objective: To study the clinical significance of liver pathological changes in patients with rheumatic heart valve disease (rheumatic heart disease, RHD). Methods: Forty one patients with RHD and tricuspid valve incompetence in 30 patients underwent heart valve replacement. Light microscopy and H 800 transmission electron microscopy were used to observe liver tissue harvested by biopsy performed before institution of cardiopulmonary bypass. Results: Typical pathological changes of liver as the following: (1) Changes of liver intercellular substance including sinusoid widening, blood stasis, liver fibroplasia. (2)Hepatocyte changes: hepatocyte swollen, mitochondria swollen, crest disappearence, hepatocyte degeneration and necrosis. There was correlation between liver pathological changes and magnitude of tricuspid valve regurgitation. Conclusion: To improve liver pathological changes, it is important to operate on patients with rheumatic heart diseases and tricuspid valve incompetence as early as possible and to eliminate tricuspid valve regurgitation.