Sims Sanyahumbi Amy, Sable Craig A, Beaton Andrea, Chimalizeni Yamikani, Guffey Danielle, Hosseinipour Mina, Karlsten Melissa, Kazembe Peter N, Kennedy Neil, Minard Charles G, Penny Daniel J
Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
Children's National Medical Center, Washington, DC.
Congenit Heart Dis. 2016 Dec;11(6):615-621. doi: 10.1111/chd.12353. Epub 2016 Mar 31.
Rheumatic heart disease (RHD) is the largest cardiac cause of morbidity and mortality in the world's youth. Early detection of RHD through echocardiographic screening in asymptomatic children may identify an early stage of disease, when secondary prophylaxis has the greatest chance of stopping disease progression. Latent RHD signifies echocardiographic evidence of RHD with no known history of acute rheumatic fever and no clinical symptoms.
Determine the prevalence of latent RHD among children ages 5-16 in Lilongwe, Malawi.
This is a cross-sectional study in which children ages 5 through 16 were screened for RHD using echocardiography.
Screening was conducted in 3 schools and surrounding communities in the Lilongwe district of Malawi between February and April 2014.
Children were diagnosed as having no, borderline, or definite RHD as defined by World Heart Federation criteria. The primary reader completed offline reads of all studies. A second reader reviewed all of the studies diagnosed as RHD, plus a selection of normal studies. A third reader served as tiebreaker for discordant diagnoses. The distribution of results was compared between gender, location, and age categories using Fisher's exact test.
The prevalence of latent RHD was 3.4% (95% CI = 2.45, 4.31), with 0.7% definite RHD and 2.7% borderline RHD. There was no significant differences in prevalence between gender (P = .44), site (P = .6), urban vs. peri-urban (P = .75), or age (P = .79). Of those with definite RHD, all were diagnosed because of pathologic mitral regurgitation (MR) and 2 morphologic features of the mitral valve. Of those with borderline RHD, most met the criteria by having pathological MR (92.3%).
Malawi has a high rate of latent RHD, which is consistent with other results from sub-Saharan Africa. This study strongly supports the need for a RHD prevention and control program in Malawi.
风湿性心脏病（RHD）是全球青少年发病和死亡的最主要心脏病因。通过超声心动图筛查对无症状儿童进行RHD的早期检测，可能会在疾病早期阶段确诊，此时二级预防最有可能阻止疾病进展。潜伏性RHD是指有RHD的超声心动图证据，但无急性风湿热病史且无临床症状。
确定马拉维利隆圭5至16岁儿童中潜伏性RHD的患病率。
这是一项横断面研究，对5至16岁的儿童进行超声心动图RHD筛查。
2014年2月至4月间，在马拉维利隆圭区的3所学校及周边社区进行筛查。
根据世界心脏联盟标准，将儿童诊断为无RHD、临界RHD或确诊RHD。主要阅片者对所有研究进行离线阅片。第二位阅片者复查所有诊断为RHD的研究以及部分正常研究。第三位阅片者解决诊断不一致的问题。采用Fisher精确检验比较性别、地点和年龄组之间的结果分布。
潜伏性RHD的患病率为3.4%（95%CI = 2.45, 4.31），确诊RHD为0.7%，临界RHD为2.7%。性别（P = 0.44）、地点（P = 0.6）、城市与城郊（P = 0.75）或年龄（P = 0.79）之间的患病率无显著差异。在确诊RHD的儿童中，均因病理性二尖瓣反流（MR）和二尖瓣的2种形态学特征而确诊。在临界RHD的儿童中，大多数（92.3%）因病理性MR符合标准。
马拉维潜伏性RHD的患病率较高，这与撒哈拉以南非洲的其他研究结果一致。本研究有力支持了在马拉维开展RHD预防和控制项目的必要性。
