急性和复发性风湿热的结局。

Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Paediatr Int Child Health. 2024 May;44(1):13-17. doi: 10.1080/20469047.2024.2313330. Epub 2024 Feb 16.

BACKGROUND

Rheumatic carditis is the leading cause of permanent disability caused by damage of the cardiac valve. This study aimed to determine the outcome and predictors of valve surgery in patients with acute rheumatic fever (ARF) and recurrent rheumatic fever (RRF).

METHODS

This was a retrospective study of patients diagnosed with ARF and RRF between 2006 and 2021. The predictors of valve surgery were analysed using multivariable Cox proportional regression.

RESULTS

The median age of patients with ARF and RRF (92) was 11 years (range 5-18). Seventeen patients (18%) were diagnosed with RRF. The most common presenting symptoms included clinical carditis (87%), heart failure (HF) (63%), fever (49%) and polyarthralgia (24%). Patients with moderate-to-severe rheumatic carditis (88%) were given prednisolone. After treatment, the severity of valvular regurgitation was reduced in 52 patients (59%). Twenty-three patients (25%) underwent valve surgery. The incidence of HF, RRF, severe mitral regurgitation on presentation, left ventricular enlargement and pulmonary hypertension was greater in the surgical group than in the non-surgical group. Recurrent rheumatic fever (hazard ratio 7.9, 95% CI 1.9-33.1), tricuspid regurgitation (TR) gradient ≥ 42 mmHg (HR 6.3, 95%CI 1.1-38.7) and left ventricular end-diastolic dimension (LVEDD) ≥6 cm (HR 8.7, 95% CI 2.1-35.9) were predictors of valve surgery (multivariable Cox proportional regression analysis).

CONCLUSION

Clinical carditis was the most common presenting symptom in patients with ARF and RRF. The majority of patients responded positively to prednisolone. These findings highlight the predictors of valve surgery following ARF, including RRF, TR gradient ≥ 42 mmHg and LVEDD ≥ 6 cm. ARF: acute rheumatic fever; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; GAS: group A beta-haemolytic Streptococcus; HF: heart failure; HR: hazard ratio; LVEDD: left ventricular end-diastolic dimension; MR: mitral regurgitation; RHD: rheumatic heart disease; RRF: recurrent rheumatic fever; TR: tricuspid regurgitation.

背景

风湿性心脏病是由心脏瓣膜损伤引起的永久性残疾的主要原因。本研究旨在确定急性风湿热（ARF）和复发性风湿热（RRF）患者瓣膜手术的结果和预测因素。

方法

这是一项对 2006 年至 2021 年间诊断为 ARF 和 RRF 的患者进行的回顾性研究。使用多变量 Cox 比例风险回归分析瓣膜手术的预测因素。

结果

ARF 和 RRF 患者的中位年龄为 11 岁（范围 5-18 岁）。17 名患者（18%）被诊断为 RRF。最常见的临床表现包括临床心内膜炎（87%）、心力衰竭（HF）（63%）、发热（49%）和多关节炎（24%）。88%的中重度风湿性心内膜炎患者给予泼尼松龙治疗。治疗后，52 名患者（59%）的瓣膜反流程度减轻。23 名患者（25%）接受了瓣膜手术。手术组 HF、RRF、发病时严重二尖瓣反流、左心室扩大和肺动脉高压的发生率高于非手术组。复发性风湿热（风险比 7.9，95%可信区间 1.9-33.1）、三尖瓣反流梯度≥42mmHg（风险比 6.3，95%可信区间 1.1-38.7）和左心室舒张末期内径（LVEDD）≥6cm（风险比 8.7，95%可信区间 2.1-35.9）是瓣膜手术的预测因素（多变量 Cox 比例风险回归分析）。

结论

临床心内膜炎是 ARF 和 RRF 患者最常见的临床表现。大多数患者对泼尼松龙反应良好。这些发现强调了 ARF 后瓣膜手术的预测因素，包括 RRF、TR 梯度≥42mmHg 和 LVEDD≥6cm。ARF：急性风湿热；CRP：C 反应蛋白；ESR：红细胞沉降率；GAS：A 组β溶血性链球菌；HF：心力衰竭；HR：风险比；LVEDD：左心室舒张末期内径；MR：二尖瓣反流；RHD：风湿性心脏病；RRF：复发性风湿热；TR：三尖瓣反流。