Thatai D, Turi Z G
Wayne State University School of Medicine, Detroit, Michigan, USA.
Drugs. 1999 Apr;57(4):545-55. doi: 10.2165/00003495-199957040-00007.
Rheumatic fever is a multisystem inflammatory disease that occurs as a delayed sequelae to group A streptococcal pharyngitis. The important clinical manifestations are migratory polyarthritis, carditis, chorea, subcutaneous nodules and erythema marginatum occurring in varying combinations. The pathogenesis of this disorder remains elusive: an antigenic mimicry hypothesis best explains the affliction of various organ systems after a lag period following pharyngeal infection. In its classic milder form, the disorder is largely self-limited and resolves without sequelae, but carditis may be fatal in severe forms of the disease. Chronic and progressive damage to the heart valves leads to the most important public health manifestations of the disease. Anti-inflammatory agents provide dramatic clinical improvement, but do not prevent the subsequent development of rheumatic heart disease. The role of corticosteroids in treatment of carditis is uncertain and controlled studies have failed to demonstrate improved long term prognosis. Chorea, once considered a benign self-limited disease, is now felt to require more aggressive treatment, in particular with sedatives. Prevention of first and subsequent attacks of rheumatic fever is the mainstay in the limited arsenal available to alter the natural history of this disease.
风湿热是一种多系统炎症性疾病，是A组链球菌性咽炎的延迟后遗症。重要的临床表现为游走性多关节炎、心肌炎、舞蹈病、皮下结节和边缘性红斑，这些症状会以不同组合出现。这种疾病的发病机制仍然不明：抗原模拟假说是对咽部感染后经过一段潜伏期各种器官系统受累情况的最佳解释。在其典型的较轻形式中，该疾病在很大程度上是自限性的，可自行缓解且不留后遗症，但在疾病的严重形式中，心肌炎可能是致命的。心脏瓣膜的慢性进行性损害导致了该疾病最重要的公共卫生表现。抗炎药物能显著改善临床症状，但不能预防随后风湿性心脏病的发生。皮质类固醇在心肌炎治疗中的作用尚不确定，对照研究未能证明其能改善长期预后。舞蹈病曾被认为是一种良性自限性疾病，现在认为需要更积极的治疗，尤其是使用镇静剂。预防风湿热的首次发作和后续发作是改变这种疾病自然病程的有限手段中的主要方法。
