儿童急性风湿热的模式：沙特阿拉伯利雅得儿童医院的经验。
The pattern of acute rheumatic fever in children: Experience at the children's hospital, Riyadh, Saudi Arabia.
作者信息
Qurashi Mansour Al
机构信息
Al-Yamamah Hospital, P.O. Box 60989, Riyadh 11555, Saudi Arabia.
出版信息
J Saudi Heart Assoc. 2009 Oct;21(4):215-20. doi: 10.1016/j.jsha.2009.10.004.
BACKGROUND
The study was carried out in Riyadh City Hospital to determine the hospital prevalence of acute rheumatic fever (ARF), its characteristics and to determine the proportion of the ARF population that have recurrent attacks.
METHODS
The study was an analysis of 83 children with ARF, admitted to the Children's Hospital, Riyadh, over a 10-year period (1994-2003). The diagnosis of ARF was based on clinical features as defined in the modified Jones criteria with evidence of recent streptococcal infection. The diagnosis of recurrence of rheumatic fever in children with rheumatic heart disease was based on the presence of one major criterion apart from carditis or two minor criteria, in addition to evidence of preceding streptococcal infection.
RESULTS
The mean age at presentation was 9 years. In 31 (37%) cases, arthritis was the only major Jones criterion. In 30 (36%) others, arthritis was associated with carditis and in 3 (4%), with chorea. Cardiac involvement was documented in 44 (53%) cases; it occurred alone in 5 (6%), with arthritis in 30 (36%), and with chorea in 9 (11%) others. Among the 44 with carditis, the pattern of cardiac involvement was valvular only (mild carditis) in 30 (68%), while it was severe in the remaining 14 (32%) cases who also had heart failure. The involvement of the mitral valve alone occurred in 26 (59%) cases in the form mitral regurgitation, while both aortic and mitral valve regurgitation were present in 11 (25%) cases, and aortic valve regurgitation alone in four (9%) others. Chorea was the only major criterion of ARF in 5 children (6%), while it occurred in association with other major criteria in 12 (15%) others. Nineteen (23%) children had recurrent attacks of ARF.
CONCLUSION
ARF continues to occur in Saudi Arabia in the period (1994-2003), despite the progress made in the socio-economic development of the country, and this is often associated with severe cardiac involvement.
背景
该研究在利雅得市医院开展，旨在确定急性风湿热（ARF）的医院患病率、其特征，并确定复发ARF人群的比例。
方法
该研究分析了10年间（1994 - 2003年）收治于利雅得儿童医院的83例ARF患儿。ARF的诊断基于改良琼斯标准所定义的临床特征以及近期链球菌感染的证据。风湿性心脏病患儿风湿热复发的诊断基于除心肌炎外存在一项主要标准或两项次要标准，以及先前链球菌感染的证据。
结果
患儿就诊时的平均年龄为9岁。在31例（37%）病例中，关节炎是唯一的主要琼斯标准。在另外30例（36%）中，关节炎与心肌炎相关，3例（4%）与舞蹈病相关。44例（53%）病例有心脏受累记录；单独出现心脏受累的有5例（6%），与关节炎同时出现的有30例（3636%），与舞蹈病同时出现的有9例（11%）。在44例心肌炎患儿中，心脏受累模式仅为瓣膜性（轻度心肌炎）的有30例（68%），而其余14例（32%）病情严重且伴有心力衰竭。单独二尖瓣受累的有26例（59%），表现为二尖瓣反流，主动脉瓣和二尖瓣反流同时存在的有11例（25%），单独主动脉瓣反流的有4例（9%）。舞蹈病是5例（6%）患儿ARF的唯一主要标准，与其他主要标准同时出现的有12例（15%）。19例（23%）患儿有ARF复发发作。
结论
尽管沙特阿拉伯在社会经济发展方面取得了进步，但在1994 - 2003年期间ARF仍有发生，且这常与严重心脏受累相关。
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