近十年来华南地区 122 例风湿热患者临床表现变化。

Changes of manifestations of 122 patients with rheumatic fever in South China during last decade.

机构信息

Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China.

出版信息

Rheumatol Int. 2009 Dec;30(2):239-43. doi: 10.1007/s00296-009-0944-1.

DOI:10.1007/s00296-009-0944-1

PMID:19444451

Abstract

The main objective of this study is to investigate changes of features of rheumatic fever (RF) in recent 10 years. A total of 315 patients with RF during 1985–1995 (group 1) and 1997–2007(group 2) were selected. Their manifestations were compared. Results show that the female/male ratio was 2.0. Group 2 had higher rate of low-grade fever and carditis, and lower rate of heart failure, lower positive rate of C-reactive protein and antistreptolycin o than group 1. In group 2, 61.4% patients fulfilled the updated Jones criteria, however, 76.2% fulfilled 2002–2003 WHO criteria. Diagnosing rheumatic carditis, sensibility and specificity of lymphocyte procoagulant activity (PCA) were 79.1 and 71.4%, respectively, and those of antibody to streptococcal polysaccharide (ASP) were 70.3 and 70%, respectively. Follow-up data of 35 cases were available. Recurrent rate of RF was 62.8%. Only 1/3 cases received regular secondary prevention. In conclusion, mild carditis was increasing. PCA and ASP were valuable tests for diagnosing rheumatic carditis. Atypical cases and secondary prevention need more attention.

摘要

本研究的主要目的是探讨近 10 年来风湿热（RF）特征的变化。选择 1985-1995 年（第 1 组）和 1997-2007 年（第 2 组）的 315 例 RF 患者，比较其临床表现。结果显示，女性/男性比例为 2.0。第 2 组低热和心肌炎发生率较高，心力衰竭发生率较低，C 反应蛋白和抗链球菌溶血素 O 阳性率较低。第 2 组中，61.4%的患者符合修订后的琼斯标准，但符合 2002-2003 年世卫组织标准的患者为 76.2%。淋巴细胞促凝活性（PCA）诊断风湿性心肌炎的敏感性和特异性分别为 79.1%和 71.4%，抗链球菌多糖抗体（ASP）的敏感性和特异性分别为 70.3%和 70%。35 例患者的随访资料可用。RF 的复发率为 62.8%。仅有 1/3 的患者接受了常规二级预防。结论：轻度心肌炎的发生率在增加。PCA 和 ASP 是诊断风湿性心肌炎的有价值的检查方法。不典型病例和二级预防需要更多关注。