Mirabel Mariana, Fauchier Thomas, Bacquelin Raoul, Tafflet Muriel, Germain Agnès, Robillard Corinne, Rouchon Bernard, Marijon Eloi, Jouven Xavier
INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Cardiology & Development, Paris, France.
INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France; Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie.
Int J Cardiol. 2015 Jun 1;188:89-95. doi: 10.1016/j.ijcard.2015.04.007. Epub 2015 Apr 2.
The objective of this study is to assess the outcomes of rheumatic heart disease (RHD) diagnosed by means of echocardiography-based screening.
A cohort of children with and with no RHD was driven from a systematic echocardiography-based nationwide surveillance among 4th grade (age 9-10 years) schoolchildren in South-Pacific New Caledonia (2008-2011). The specific follow-up programme used clinical and standardised echocardiography (2012 World Heart Federation criteria) predefined endpoints.
Out of the 17,633 children screened, 157 were detected with findings of RHD. Among them, 114 consented children (76.5%) were enrolled (RHD-group), and were compared to 227 randomly selected healthy classmates (non-RHD group). After a median follow-up period of 2.58 years [1.31-3.63], incidence of acute rheumatic fever was similar in RHD and non-RHD groups (p=0.23): 10.28/1000/year and 3.31/1000/year, respectively. By echocardiography, 90 children in the RHD group (78.9%) still presented with RHD at follow-up, compared to 31 (13.7%) in the non-RHD group (p<0.0001). Only 12 children (10.5%) experienced progression of RHD over time, mild single valve disease lesions remaining unchanged in the majority of cases (61 out of 73, 83.6%). Overcrowded living conditions were independently associated with persistent RHD on echocardiography (OR 8.27 95% CI (1.67-41.08), p<0.01). Benzathine penicillin G was given in 88.6% of children in the RHD-group.
Children screened positive for RHD by echocardiography have mostly mild but irreversible heart valve disease under secondary prophylaxis. Our findings also suggest that a single screening point in childhood may prove insufficient in high-risk populations.
本研究旨在评估通过基于超声心动图的筛查诊断出的风湿性心脏病（RHD）的预后情况。
对南太平洋新喀里多尼亚地区四年级（9至10岁）学童进行基于超声心动图的全国性系统监测，从中选取一组患有和未患RHD的儿童。具体的随访方案采用临床和标准化超声心动图（2012年世界心脏联盟标准）预先定义的终点。
在筛查的17,633名儿童中，有157名被检测出患有RHD。其中，114名同意参与的儿童（76.5%）被纳入研究（RHD组），并与227名随机挑选的健康同班同学（非RHD组）进行比较。在中位随访期2.58年[1.31 - 3.63]后，RHD组和非RHD组的急性风湿热发病率相似（p = 0.23）：分别为每年10.28/1000和每年3.31/1000。通过超声心动图检查，随访时RHD组中有90名儿童（78.9%）仍患有RHD，而非RHD组中有31名（13.7%）（p < 0.0001）。只有12名儿童（10.5%）随着时间推移出现RHD病情进展，大多数病例（73例中的61例，83.6%）轻度单瓣膜疾病病变保持不变。居住环境拥挤与超声心动图显示的持续性RHD独立相关（比值比8.27，95%置信区间(1.67 - 41.08)，p < 0.01）。RHD组中88.6%的儿童接受了苄星青霉素G治疗。
通过超声心动图筛查RHD呈阳性的儿童在二级预防下大多患有轻度但不可逆的心脏瓣膜疾病。我们的研究结果还表明，在高危人群中，儿童期单一的筛查点可能是不够的。
