Regmi P R, Pandey M R
Mrigendra Samjhana Medical Trust, Thapathati, Kathmandu, Nepal.
Indian Heart J. 1997 Sep-Oct;49(5):518-20.
To find out the prevalence of rheumatic fever/rheumatic heart disease in an urban area, a survey of school children aged between 5 to 16 years studying in randomly selected government schools in Kathmandu city was done. Out of 4984 students enrolled in the study 4736 were examined, the percentage of absentees being five. Revised Jones Criteria (1992) was used for the diagnosis of rheumatic fever. Diagnosis of rheumatic heart disease was confirmed only after Doppler echocardiography in suspected cases. A total of six cases of definite rheumatic heart disease (out of 13 suspected cases) were identified giving overall prevalence rate of 1.2 per 1000. Fifty percent rheumatic heart disease cases gave a history suggestive of rheumatic fever. No case of active rheumatic fever could be identified. The study gave lower result than that reported in most earlier studies from developing countries but it is similar to that reported from rural Kathmandu in 1991. It is concluded that there is some downward trend in rheumatic fever/rheumatic heart disease prevalence but the low prevalence is also due to the use of Doppler echocardiography which has prevented overdiagnosis in the present study. We feel that there is an urgent need to launch a National Programme for the control of rheumatic fever/rheumatic heart disease in Nepal with emphasis on primary and secondary prophylaxis of the disease.
为了查明加德满都市中心城区风湿热/风湿性心脏病的患病率，我们对加德满都随机抽取的政府学校中5至16岁的在校儿童进行了一项调查。在4984名登记参与研究的学生中，4736人接受了检查，缺勤率为5%。采用修订的琼斯标准（1992年）诊断风湿热。仅在疑似病例中通过多普勒超声心动图确诊风湿性心脏病。共确诊了6例明确的风湿性心脏病（13例疑似病例中），总体患病率为每1000人中有1.2例。50%的风湿性心脏病病例有风湿热病史。未发现活动性风湿热病例。该研究结果低于大多数发展中国家早期研究报告的结果，但与1991年加德满都农村地区报告的结果相似。结论是，风湿热/风湿性心脏病患病率有一定下降趋势，但患病率较低也归因于使用了多普勒超声心动图，这在本研究中避免了过度诊断。我们认为，尼泊尔迫切需要启动一项控制风湿热/风湿性心脏病的国家计划，重点是对该疾病进行一级和二级预防。
