Tani Lloyd Y, Veasy L George, Minich L LuAnn, Shaddy Robert E
Department of Pediatrics, University of Utah, and Primary Children's Medical Center, Salt Lake City, UT 84113, USA.
Pediatrics. 2003 Nov;112(5):1065-8. doi: 10.1542/peds.112.5.1065.
To review our experience with children who presented with rheumatic fever (RF) before 5 years of age and to compare their presentation with that of older children.
The cardiology database was reviewed to identify patients who were younger than 5 years and had a diagnosis RF using the Jones criteria from January 1985 through March 2000. Patient age, sex, date and age at presentation, and the major Jones criteria fulfilled were noted. When carditis was present, its severity was judged to be moderate to severe when there was radiographic cardiomegaly and/or clinical congestive heart failure. The clinical presentation of patients who presented in the first 5 years of life were compared with the presentation of those whose RF was diagnosed after 5 years of age. Clinical findings at follow-up evaluation and echocardiographic findings both at presentation and at follow-up were noted for the children who were younger than 5 years at presentation.
Of 541 cases of RF seen from January 1985 through March 20000, 27 (5%) were in children who were younger than 5 years (median: 4.0 years; range: 1.9-4.9 years). Major Jones criteria at presentation were arthritis in 17, carditis in 14, chorea in 3, and erythema marginatum in 3. The carditis was mild in 4 and moderate to severe in 10 patients. Compared with older children, younger children were more likely to present with moderate to severe carditis, arthritis without carditis or chorea, or the rash of erythema marginatum and were less likely to have chorea. The incidence of carditis was similar in the 2 groups as was the ratio of boys to girls. At follow-up (9.6 +/- 5.6 years), 69% of younger children who presented with carditis have clinical rheumatic heart disease. Subclinical, echocardiographically detected valvular abnormalities were detected both at presentation (33% of all children with RF before 5 years of age) and at follow-up (55% of those who initially had carditis).
Approximately 5% of children with RF were younger than 5 years at diagnosis. Compared with older patients, children who presented before 5 years of age were more likely to have moderate to severe carditis and to present with arthritis or the rash of erythema marginatum and were less likely to have chorea. Chronic rheumatic heart disease was common in young children who presented with carditis. Long-term follow-up is necessary to determine the outcome for young children with subclinical echocardiographic evidence of valvular disease.
回顾我们对5岁前出现风湿热（RF）患儿的诊治经验，并将其临床表现与大龄儿童进行比较。
查阅心脏病学数据库，以确定1985年1月至2000年3月期间年龄小于5岁且根据琼斯标准诊断为RF的患者。记录患者的年龄、性别、就诊日期和年龄，以及所满足的主要琼斯标准。当存在心脏炎时，若有X线胸片显示心脏扩大和/或临床充血性心力衰竭，则判断其严重程度为中度至重度。将5岁前发病患者的临床表现与5岁后诊断为RF患者的临床表现进行比较。记录5岁前发病患儿随访评估时的临床表现以及就诊时和随访时的超声心动图检查结果。
在1985年1月至2000年3月期间所见的541例RF病例中，27例（5%）为5岁以下儿童（中位数：4.0岁；范围：1.9 - 4.9岁）。就诊时的主要琼斯标准为：关节炎17例，心脏炎14例，舞蹈病3例，边缘性红斑3例。4例心脏炎为轻度，10例为中度至重度。与大龄儿童相比，小龄儿童更易出现中度至重度心脏炎、无心脏炎的关节炎或舞蹈病，或边缘性红斑皮疹，且患舞蹈病的可能性较小。两组心脏炎的发生率以及男女性别比相似。在随访（9.6±5.6年）时，5岁前出现心脏炎的小龄儿童中有69%患有临床风湿性心脏病。在就诊时（所有5岁前患RF儿童的33%）和随访时（最初患有心脏炎儿童的55%）均检测到亚临床的、超声心动图发现的瓣膜异常。
约5%的RF患儿诊断时年龄小于5岁。与大龄患者相比，5岁前发病的儿童更易出现中度至重度心脏炎，且易出现关节炎或边缘性红斑皮疹，患舞蹈病的可能性较小。患有心脏炎的幼儿中慢性风湿性心脏病很常见。对于有亚临床超声心动图证据显示瓣膜病的幼儿，需要进行长期随访以确定其预后。
