Yavuz Taner, Nisli Kemal, Oner Naci, Dindar Aygun, Aydogan Umrah, Omeroglu Rukiye Eker, Ertugrul Turkan
Department of Paediatrics, Faculty of Medicine, University of Duzce, Konuralp, Duzce, Turkey.
Eur J Pediatr. 2008 Nov;167(11):1321-6. doi: 10.1007/s00431-008-0799-6. Epub 2008 Jul 31.
We aimed to evaluate the predictors of the severity of chronic rheumatic valvar disease. The long term follow-up records of 139 patients with chronic rheumatic carditis were reviewed. Children were followed-up on an outpatient basis for a period ranging from 1-16 years (5.0 +/- 3.7 years). Mitral regurgitation either isolated (51%, n=71) or combined with aortic regurgitation (AR) (49%, n=68) was observed in all cases of the initial attack of rheumatic carditis. AR at initial attack of the rheumatic carditis was found to be affected by gender (AR was more associated with males, p = 0.032), combined mitral and aortic regurgitation (CMAR), and presence of MR at initial attack (p = 0.000 and p = 0.012, respectively) with univariate analysis. The effect of CMAR on AR at initial attack was also significant by multivariate analysis (p = 0.000). CMAR, MR, and AR at initial attack had significant effects on CMAR at final evaluation (p = 0.000, p = 0.020, and p = 0.000, respectively) in univariate analysis. Multivariate analysis revealed the significant effects of CMAR and MR at initial attack on CMAR at final evaluation (p = 0.000 and p = 0.005, respectively). Univariate analysis showed that MR and AR at initial attack, and CMAR at final evaluation, had significant effects on MR at final evaluation (p = 0.000, p = 0.029, and p = 0.000, respectively). MR at initial attack and CMAR at final evaluation had significant effects on MR at final evaluation with multivariate analysis (p = 0.001 and p = 0.003, respectively). AR at final evaluation was affected by CMAR and AR at initial attack (p = 0.000 and p = 0.000, respectively), and CMAR and MR at final evaluation (p = 0.000 and p = 0.000, respectively) with both univariate and multivariate analysis. Mitral valve prolapsus was more common in patients with a longer duration (37.5%, 6 out of 16) than those with a shorter duration (11%, 14 out of 123) and the difference was significant (p = 0.020). In conclusion, the initial severity of valve involvement and the presence of CMAR at initial attack were found to be the best predictors for the severity of chronic rheumatic valvar disease in this study.
我们旨在评估慢性风湿性瓣膜病严重程度的预测因素。回顾了139例慢性风湿性心脏病患者的长期随访记录。儿童在门诊接受随访，随访时间为1至16年（5.0±3.7年）。在所有风湿性心脏病初发病例中均观察到二尖瓣反流，单独存在（51%，n = 71）或合并主动脉瓣反流（AR）（49%，n = 68）。单因素分析发现，风湿性心脏病初发时的AR受性别影响（AR与男性更相关，p = 0.032）、二尖瓣和主动脉瓣联合反流（CMAR）以及初发时存在MR（分别为p = 0.000和p = 0.012）。多因素分析显示CMAR对风湿性心脏病初发时AR也有显著影响（p = 0.000）。单因素分析中，CMAR、初发时的MR和AR对最终评估时的CMAR有显著影响（分别为p = 0.000、p = 0.020和p = 0.000）。多因素分析显示初发时的CMAR和MR对最终评估时的CMAR有显著影响（分别为p = 0.000和p = 0.005）。单因素分析表明，初发时的MR和AR以及最终评估时的CMAR对最终评估时的MR有显著影响（分别为p = 0.000、p = 0.029和p = 0.000）。多因素分析显示初发时的MR和最终评估时的CMAR对最终评估时的MR有显著影响（分别为p = 0.001和p = 0.003）。单因素和多因素分析均显示，最终评估时的AR受初发时的CMAR和AR影响（分别为p = 0.000和p = 0.000），以及最终评估时的CMAR和MR影响（分别为p = 0.000和p = 0.000）。二尖瓣脱垂在病程较长的患者中更常见（37.5%，16例中有6例），而在病程较短的患者中较少见（11%，123例中有14例），差异有统计学意义（p = 0.020）。总之，本研究发现瓣膜受累的初始严重程度和初发时存在CMAR是慢性风湿性瓣膜病严重程度的最佳预测因素。
