Kotit Susy, Said Karim, ElFaramawy Amr, Mahmoud Hani, Phillips David I W, Yacoub Magdi H
National Heart and Lung Institute, Imperial College, London, UK.
Aswan Heart Centre, Aswan, Egypt.
Open Heart. 2017 Dec 17;4(2):e000702. doi: 10.1136/openhrt-2017-000702. eCollection 2017.
Rheumatic heart disease (RHD) remains a major health problem in many low-income and middle-income countries. The use of echocardiographic imaging suggests that subclinical disease is far more widespread than previously appreciated, but little is known as to how these mild forms of RHD progress. We have determined the prevalence of subclinical RHD in a large group of schoolchildren in Aswan, Egypt and have evaluated its subsequent progression.
Echocardiographic screening was performed on 3062 randomly selected schoolchildren, aged 5-15 years, in Aswan, Egypt. Follow-up of children with a definite or borderline diagnosis of RHD was carried out 48-60 months later to determine how the valvular abnormalities altered and to evaluate the factors influencing progression.
Sixty children were initially diagnosed with definite RHD (19.6 per 1000 children) and 35 with borderline disease (11.4 per 1000); most had mitral valve disease. Of the 72 children followed up progression was documented in 14 children (19.4%) and regression in 30 (41.7%) children. Boys had lower rates of progression while older children had lower rates of regression. Functional defects of the valve even in the presence of structural features were associated with lower rates of progression and higher rates of regression than structural changes.
RHD has a high prevalence in Egypt. Although a high proportion of the abnormalities originally detected persisted at follow-up, both progression and regression of valve lesions were demonstrated.
风湿性心脏病（RHD）在许多低收入和中等收入国家仍然是一个主要的健康问题。超声心动图成像显示，亚临床疾病的分布比之前认为的要广泛得多，但对于这些轻度RHD的进展情况却知之甚少。我们已经确定了埃及阿斯旺一大群学童中亚临床RHD的患病率，并评估了其后续进展。
对埃及阿斯旺随机抽取的3062名5至15岁学童进行了超声心动图筛查。对确诊或疑似RHD的儿童在48至60个月后进行随访，以确定瓣膜异常如何变化，并评估影响进展的因素。
最初有60名儿童被确诊为RHD（每1000名儿童中有19.6例），35名儿童疑似患病（每1000名儿童中有11.4例）；大多数患有二尖瓣疾病。在随访的72名儿童中，有14名儿童（19.4%）病情进展，30名儿童（41.7%）病情缓解。男孩的病情进展率较低，而年龄较大的儿童病情缓解率较低。即使存在结构特征，瓣膜的功能缺陷与结构变化相比，病情进展率较低，病情缓解率较高。
RHD在埃及的患病率很高。虽然最初检测到的大部分异常在随访中持续存在，但瓣膜病变的进展和缓解均有发生。
