Majeed H A, Batnager S, Yousof A M, Khuffash F, Yusuf A R
Department of Pediatrics, Faculty of Medicine, University of Kuwait, Safat.
J Clin Epidemiol. 1992 Aug;45(8):871-5. doi: 10.1016/0895-4356(92)90070-4.
Sixty four children who presented with the initial attack of acute rheumatic fever and maintained continuous regular secondary prophylaxis, were followed up prospectively for 12.3 years (an observation period of 775 patient-years). The prevalence rate of rheumatic heart disease in the 29 children who had carditis in the initial attack and in the 35 children who had no carditis initially was 49 vs 0%, respectively. The overall prevalence rate of rheumatic heart disease was 20%. Mitral incompetence developed in 11 patients (17%), aortic incompetence in 2 (3%) and mitral stenosis in 2 (3%). None of the patients developed aortic stenosis. Two recurrences developed with a recurrence rate of 0.003 per patient per year. One patient needed cardiac surgery and there was no mortality. These data strongly suggest that continuous regular secondary prophylaxis can prevent or significantly reduce the development of mitral and aortic valve stenosis, the prevalence rate of rheumatic heart disease and mortality.
64名首次发作急性风湿热且持续接受定期二级预防的儿童，进行了为期12.3年的前瞻性随访（观察期为775患者年）。首次发作时有心肌炎的29名儿童和最初无心肌炎的35名儿童中，风湿性心脏病的患病率分别为49%和0%。风湿性心脏病的总体患病率为20%。11例患者（17%）出现二尖瓣关闭不全，2例（3%）出现主动脉瓣关闭不全，2例（3%）出现二尖瓣狭窄。无患者出现主动脉瓣狭窄。发生了2次复发，复发率为每年每例患者0.003次。1例患者需要心脏手术，无死亡病例。这些数据有力地表明，持续定期二级预防可预防或显著降低二尖瓣和主动脉瓣狭窄的发生、风湿性心脏病的患病率及死亡率。
