儿童风湿热和风心病60例临床分析

收集1983年1月～1993年1月按修定的Jones标准诊断为风湿热和风心病并风湿活动的5～15岁患儿共60例,并进行了分析,认为诊断风湿热或风湿活动应开展多项目、多指标联合检查,并结合临床综合分析。强的松与阿斯匹林联合应用较单一用药为优,并应坚持全疗程。预防风心病关键在于防止风湿热的复发.     

小儿风湿热及风湿性心脏病的临床特点分析

目的探讨小儿风湿热及风湿性心脏病的特点,从而为临床诊断和治疗提供指导。方法将2007年1月～2012年1月期间在本院住院治疗的70例因风湿热致风湿性心脏病患儿根据症状典型与否分为观察组43例和对照组27例,回顾性分析和比较两组患儿临床体征和实验室指标。结果观察组心肌炎26例,发病率为60．47％,明显高于对照组的33．33％（χ2=4．513,P〈0．05）;对照组多发性关节炎合并心脏炎、心力衰竭、关节痛发病率分别为55．56％、11．1l％和81．48％,显著高于观察组的30．23％、0．0％和53．49％（χ2=4．304、3．879、3．962,均P〈0．05）;两组患儿ERS增快发生率与AS0阳性率比较无显著性差异（P〉0．05）;观察组GAS指标阳性人数显著高于对照组（χ2=5．026,P〈0．05）,而对照组CoxB阳性例数显著高于观察组（χ2=3．968,P〈0．05）,提示临床症状典型患儿CoxB与GAS指标与不典型患儿之间存在显著性差异（P〈0．05）。结论应加强对不典型性小儿风湿热的鉴别诊断,重视小儿风湿热及风湿性心脏病的治疗。     

An Australian guideline for rheumatic fever and rheumatic heart disease: an abridged outline

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are diseases of poverty. They occur at world-record rates in Indigenous Australians, yet individual cases are often poorly managed, and most jurisdictions with high rates of these diseases do not have formal control strategies in place. New Australian guidelines formulated in 2005 by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand for diagnosis and management of ARF and RHD are a valuable resource for clinicians and policymakers. Key recommendations of the guidelines include: New diagnostic criteria for ARF in high-risk populations, including Indigenous Australians, which include echocardiographic evidence of subclinical valvular disease, and polyarthralgia or aseptic monoarthritis as major manifestations. Clear guidance about treatment of ARF. Non-steroidal anti-inflammatory drugs should be withheld until the diagnosis is confirmed, and corticosteroids may be an option in severe acute carditis. Most cases of chorea do not require medication, but use of carbamazepine or sodium valproate is recommended if medication is needed. Clear guidance about dose, dosing frequency and duration of secondary prophylaxis. Benzathine penicillin G is the preferred medication for this purpose. Establishment of a coordinated control program for all regions of Australia where there are populations with high prevalence of ARF and RHD. Key elements and indicators for evaluation are recommended. Active screening and legislated notification of ARF and RHD, where possible. Development of a structured care plan for all patients with a history of ARF or with established RHD, to be recorded in the patient's primary health care record.     

以不明原因发热为表现的风湿性疾病192例临床分析

目的风湿性疾病是不明原因发热常见的病因之一,其病种众多、临床表现多样,诊断较难,漏诊和误诊率较高。本文探讨风湿性疾病所致不明原因发热（fever of unknown origin,FUO）的病种,分析临床特点。方法回顾性分析2004年10月～2009年10月山西医科大学第二医院风湿科住院患者资料,符合FUO标准确诊为风湿性疾病者192例。结果病种以系统性红斑狼疮（SLE,18.8%）、原发性干燥综合症（pSS,18.2%）、未分化结缔组织病（UCTD,17.2%）、未分化脊柱关节病（USpA,10.9%）、多肌炎/皮肌炎（PM/DM,10.9%）、白塞病（BD,8.3%）较多见,临床表现不典型;其他疾病较少见,共占30%左右。论风湿性疾病所致FUO病例中表现不典型的风湿性疾病是主要病种,提高对风湿性疾病的认识,合理进行检查,是诊断风湿性疾病所致FUO的关键。     

Acute rheumatic fever and rheumatic heart disease in a rural central Australian aboriginal community

A retrospective study of clinical case records was conducted at the health centre of a rural central Australian Aboriginal community to determine the frequency of acute rheumatic fever and of rheumatic heart disease between 1978 and 1987. The case records of 976 residents over 5 years of age were examined for evidence of the clinical indicators of acute rheumatic fever or rheumatic heart disease; together they contributed 8015 person-years of study. During the 10-year study period, 18 patients developed acute rheumatic fever and 12 patients had rheumatic heart disease. The annual incidence of acute rheumatic fever (first and recurrent attacks) for children aged 5-14 years was 815 per 100,000 person-years. For the residents aged 5 years and over, the point prevalence for rheumatic heart disease at the end of 1987 was between 7.9 and 12.3 per 1000 persons, according to health clinic records and the official population census, respectively. These rates are similar to those reported for Third World countries. Preventive measures must include efforts by health professionals to help to alleviate the adverse living conditions in Aboriginal communities.     

A clinical, laboratory and echocardiographic profile of children with acute rheumatic fever

A retrospective study of 42 children with acute rheumatic fever admitted to Hospital Universiti Sains Malaysia from April 1985 to March 1989 was undertaken to assess the clinical, laboratory, echocardiographic aspects and outcome. The ages of the children ranged from 5 years 9 months to 11 years 11 months. There was no significant sex difference. 69.4% were admitted between November and April with a seasonal low between May and August. Sixteen children (38.1%) were hospitalised for recurrence of rheumatic fever. Carditis was the commonest manifestation and was seen in 28 (66.6%) children, followed by arthritis in 24 (57.1%), and chorea in 3 (7.1%). Echocardiography detected abnormalities in 24 out of 35 cases and the most common echocardiographic findings were poor coaptation of mitral valve (ten) left ventricular dilatation (ten), thickened mitral valve cusps (seven) and pericardial effusion (seven). In those children followed up, there were 2 recurrences while on secondary prophylaxis and complete recovery was seen only in 11 (26.9%).     

彩色多普勒血流显像诊断风心病40例临床分析

作者用彩色多普勒血流显象诊断风湿性心脏病40例,男女各20例,年龄23岁～80岁。其中诊为单纯性二尖瓣狭窄11例;二尖瓣双病变8例:主动脉瓣及二尖瓣联合瓣膜病变19例;单纯主动脉瓣病变2例。二尖瓣病损率为95％,主动脉瓣病损率为50％。