Sanyal S K, Berry A M, Duggal S, Hooja V, Ghosh S
Circulation. 1982 Feb;65(2):375-9. doi: 10.1161/01.cir.65.2.375.
We determined the outcome of acute rheumatic fever in 85 children from North India who had received regular antistreptococcal prophylaxis after their first attack. By the end of the 5-year follow-up, 33 patients had rheumatic heart disease. Mitral insufficiency, the most common valvular lesion, appeared in 91% of the patients, whereas mitral stenosis developed in only 18%. Initial carditis, congestive heart failure, cardiomegaly or moderate-to-severe mitral insufficiency significantly increased the risk of rheumatic heart disease (p less than 0.001). The recurrence rate of acute rheumatic fever in children who received continuous prophylaxis was 0.006 per patient-year. Most recurrence (92%) mimicked the first attack and produced further cardiac damage in five patients with carditis and in one patient with chorea. Cardiac status during the first attack of rheumatic fever and the continuity of prophylaxis were the major determinants of outcome. Statistical comparisons disclosed that with continuous prophylaxis, the prevalence rate, evolution and clinical spectrum of the sequelae of acute rheumatic fever in children from India do not differ significantly from those in the West.
我们对来自印度北部的85名儿童进行了研究，这些儿童在首次发作急性风湿热后接受了常规抗链球菌预防治疗。到5年随访结束时，有33名患者患有风湿性心脏病。二尖瓣关闭不全是最常见的瓣膜病变，出现在91%的患者中，而二尖瓣狭窄仅在18%的患者中出现。初始心肌炎、充血性心力衰竭、心脏扩大或中重度二尖瓣关闭不全显著增加了风湿性心脏病的风险（p小于0.001）。接受持续预防治疗的儿童急性风湿热复发率为每人每年0.006。大多数复发（92%）类似于首次发作，并在5名患有心肌炎的患者和1名患有舞蹈病的患者中造成了进一步的心脏损害。风湿热首次发作时的心脏状况和预防治疗的连续性是预后的主要决定因素。统计比较显示，通过持续预防治疗，印度儿童急性风湿热后遗症的患病率、演变和临床谱与西方儿童并无显著差异。
