Cramp Geoffrey, Stonehouse Mary, Webb Rachel, Webb Rachel, Chaffey-Aupouri Gina, Wilson Nigel
Te Puna Waiora, Tairawhiti District Health, Private Bag 7001, Gisborne, New Zealand.
N Z Med J. 2012 Oct 12;125(1363):53-64.
The aim of this programme was to find undetected rheumatic heart disease (RHD) in students from selected schools in the Tairawhiti region (eastern part of the North Island) of New Zealand.
Portable echocardiography was used to scan students in 5 urban and rural schools in Tairawhiti where the population is predominantly Maori. The age range of students in the urban schools was 10-13 years and in the rural schools 5-17 years. Those with abnormal echocardiograms were referred for a paediatric consultation, with hospital-based echocardiography if required for the clarification of diagnoses and further management.
A total of 685 students, representing over 95% of the schools' students, consented to having echocardiographic scanning. After repeat hospital based echocardiography for 11 students, a total of 52 scans were regarded as abnormal. In this population definite (n=4) or probable (n=7) RHD was found in 11 students a prevalence of 1.61% (95%CIs 0.80-2.85). Possible RHD was found in 19 students. Previously undetected confirmed (n=1) or probable (n=7) RHD was found in 8 students a prevalence of 1.17% (95%CIs 0.51-2.29). Congenital heart defects (CHD) were found in 22 students a prevalence of 3.21% (95%CIs 2.02-4.83).
Echocardiography was a popular modality and detected a significant burden of previously unknown RHD in this young Maori population who are now receiving penicillin. However, echocardiography detected a greater prevalence of possible RHD for which optimum management is at present uncertain. Echocardiography also detected students with a range of severity of CHD. Screening with echocardiography for RHD would involve a significant use of public health, paediatric and cardiac resources with 7.6% of students and their families requiring clinical consultations and ongoing management of the abnormal echocardiographic results.
本项目旨在在新西兰泰拉威提地区（北岛东部）选定学校的学生中发现未被检测出的风湿性心脏病（RHD）。
采用便携式超声心动图对泰拉威提地区5所城乡学校的学生进行扫描，该地区人口以毛利人为主。城市学校学生的年龄范围为10至13岁，农村学校学生的年龄范围为5至17岁。超声心动图异常的学生被转介进行儿科会诊，必要时进行基于医院的超声心动图检查以明确诊断并进一步治疗。
共有685名学生（占学校学生总数的95%以上）同意接受超声心动图扫描。在对11名学生进行基于医院的重复超声心动图检查后，共有52次扫描被视为异常。在这一人群中，11名学生被发现患有确诊（n = 4）或可能（n = 7）的风湿性心脏病，患病率为1.61%（95%置信区间0.80 - 2.85）。19名学生被发现可能患有风湿性心脏病。8名学生被发现患有先前未被检测出的确诊（n = 1）或可能（n = 7）的风湿性心脏病，患病率为1.17%（95%置信区间0.51 - 2.29）。在22名学生中发现了先天性心脏病（CHD），患病率为3.21%（95%置信区间2.02 - 4.83）。
超声心动图是一种受欢迎的检查方式，在这一正在接受青霉素治疗的年轻毛利人群体中发现了大量先前未知的风湿性心脏病。然而，超声心动图检测出的可能患有风湿性心脏病的患病率更高，目前其最佳治疗方法尚不确定。超声心动图还检测出了患有不同严重程度先天性心脏病的学生。对风湿性心脏病进行超声心动图筛查将大量使用公共卫生、儿科和心脏科资源，7.6%的学生及其家庭需要临床会诊以及对异常超声心动图结果进行持续管理。
