小儿急性风湿热的实验室与心脏器械检查及分析

通过有关实验室与心脏器械检查,以发现急性风湿热(ARF)诊断的新指标。方法对114例 ARF患儿,检查抗链球菌溶血素“O”(ASO),其中60例做了咽部A组β溶血性链球菌快速鉴定(GABHSRA), 且对二者阳性率进行对比;将114例的肌酸激酶同功酶(CK-MB)、多普勒超声心动图,与健康儿童对比。 结果ARF患儿GABHSRA阳性率为90％(54/60),显著高于ASO阳性率65.8％(75/114)。114例ARF患儿 CK-MB升高者46.5％,α-羟丁酸脱氢酶升高者32.7％;超声心动图左房增大者23.7％,左室扩大者16.7％,右 室扩大者7.1％;二尖瓣增厚者13.2％,主动脉瓣增厚者8.8％;多普勒超声心动图检查二尖瓣返流者29.8％, 主动脉瓣返流者9.6％,与健康儿童相比,差异均有显著性意义。34例有二尖瓣返流患儿中29例二尖瓣返流流 速时间积分增大。结论GABHSRA、心肌酶和多普勒超声心动图检查有助于ARF的诊断与病情了解。     

HLA and rheumatic fever in Turkish children

Summary We report the results of research on human leukocyte allo-antigen (HLA) and rheumatic fever (RF), the first published study to be carried out among Turkish children with RF. Ninety-three Turkish children, aged between 6 and 16 years(mean: 8±2.6), with RF participated in the study. Of the total, 26 patients had their first attack and 39 had acute rheumatic activity at the time of registration. The results demonstrate (1) negative but not significant association between HLA-A2 and RF; (2) a positive association between HLA-DR4 and RF (p<0.001); (3) a significant association between HLA-DR4 and carditis, but not with isolated arthritis. These results corroborate the concept of race-specific genetically determined familial susceptibility to the development of rheumatic heart disease.     

Rheumatic fever and rheumatic heart disease: Primary prevention is the cost effective option

Objective To measure the economic output/input ratios for the various options of prevention of rheumatic fever/rheumatic heart disease (RF/RHD) and check the viability of primary prevention vis-à-vis secondary and tertiary preventions. Methods Cost accounting of the various prevention options was calculated for each variable as available in literature. Actual data as obtainable for the financial year ending March 2006 were computed for the Pondicherry population. Both direct and indirect costs (including community/social costs) were worked out using mostly primary data, and wherever necessary, secondary data. Certain scientific assumptions were used where exact data was not available. Results Primary prevention is the definite viable economic option (1:1.56) compared to secondary (1: 1.07) and tertiary (1: 0.12) preventions. In fact, the current stress on only secondary and tertiary preventions is found to be economically unviable. Conclusion It is postulated that primary prevention as a practical policy in tackling RF and RHD can be recommended.     

Long term follow-up results of 139 Turkish children and adolescents with rheumatic heart disease

We aimed to evaluate the predictors of the severity of chronic rheumatic valvar disease. The long term follow-up records of 139 patients with chronic rheumatic carditis were reviewed. Children were followed-up on an outpatient basis for a period ranging from 1-16 years (5.0 +/- 3.7 years). Mitral regurgitation either isolated (51%, n=71) or combined with aortic regurgitation (AR) (49%, n=68) was observed in all cases of the initial attack of rheumatic carditis. AR at initial attack of the rheumatic carditis was found to be affected by gender (AR was more associated with males, p = 0.032), combined mitral and aortic regurgitation (CMAR), and presence of MR at initial attack (p = 0.000 and p = 0.012, respectively) with univariate analysis. The effect of CMAR on AR at initial attack was also significant by multivariate analysis (p = 0.000). CMAR, MR, and AR at initial attack had significant effects on CMAR at final evaluation (p = 0.000, p = 0.020, and p = 0.000, respectively) in univariate analysis. Multivariate analysis revealed the significant effects of CMAR and MR at initial attack on CMAR at final evaluation (p = 0.000 and p = 0.005, respectively). Univariate analysis showed that MR and AR at initial attack, and CMAR at final evaluation, had significant effects on MR at final evaluation (p = 0.000, p = 0.029, and p = 0.000, respectively). MR at initial attack and CMAR at final evaluation had significant effects on MR at final evaluation with multivariate analysis (p = 0.001 and p = 0.003, respectively). AR at final evaluation was affected by CMAR and AR at initial attack (p = 0.000 and p = 0.000, respectively), and CMAR and MR at final evaluation (p = 0.000 and p = 0.000, respectively) with both univariate and multivariate analysis. Mitral valve prolapsus was more common in patients with a longer duration (37.5%, 6 out of 16) than those with a shorter duration (11%, 14 out of 123) and the difference was significant (p = 0.020). In conclusion, the initial severity of valve involvement and the presence of CMAR at initial attack were found to be the best predictors for the severity of chronic rheumatic valvar disease in this study.     

Mitral valve replacement in active rheumatic heart disease in a five years old child

A case of a five-year-old patient with severe rheumatic mitral regurgitation is reported. Intensive anticongestive and corticosteroid therapy were ineffective. Despite the diagnosis of chronic carditis she underwent successful mitral valve replacement with significant improvement of her cardiac status.Valve replacement is indicated in a certain group of patients with rheumatic heart disease which have a poor prognosis on medical therapy alone.     

Valve replacement in children under 15 years with rheumatic heart disease

Summary From 1967 through 1984, single- or double-valve replacement for rheumatic heart disease (RHD) was undertaken in 184 children (aged 4 to 15 years) in Tunis. At the time of operation most patients were in an advanced state of cardiac disability, but most of them were still in sinus rhythm. A total of 222 valves were inserted. The most commonly used replacement valve was the Starr—Edwards caged-ball prosthesis, with 12 hospital deaths (6.5%). There were no hospital deaths among 19 children who had a (glutaraldehyde-treated porcine) xenograft replacement valve; however, a much higher rate of valve failure occurred later, owing to valve calcification (14 to 19 replacements, 11 requiring reoperation). There were 24 episodes of clinical thrombo-embolism in 21 children after insertion of a prosthetic valve, but only one in a child with a xenograft valve. Two thirds of the patients with prosthetic valves were on anticoagulants, but fewer than half of them had effective levels because of low compliance. For the group with prosthetic valves, the 10-year survival rate was 70%.     

Mortality and hospitalisation costs of rheumatic fever and rheumatic heart disease in New Zealand

Aims: To estimate the annual mortality and the cost of hospital admissions for acute rheumatic fever (ARF) and rheumatic heart disease (RHD) for New Zealand residents. Methods: Hospital admissions in 2000–2009 with a principal diagnosis of ARF or RHD (ICD9_AM 390‐398; ICD10‐AM I00‐I099) and deaths in 2000–2007 with RHD as the underlying cause were obtained from routine statistics. The cost of each admission was estimated by multiplying its diagnosis‐related group (DRG) cost weight by the national price for financial year 2009/2010. Results: There were on average 159 RHD deaths each year with a mean annual mortality rate of 4.4 per 100 000 (95% confidence limit 4.2, 4.7). Age‐adjusted mortality was five‐ to 10‐fold higher for Māori and Pacific peoples than for non‐Māori/Pacific. The mean age at RHD death (male/female) was 56.4/58.4 for Māori, 50.9/59.8 for Pacific and 78.2/80.6 for non‐Māori, non‐Pacific men and women. The average annual DRG‐based cost of hospital admissions in 2000–2009 for ARF and RHD across all age groups was $12.0 million (95% confidence limit $11.1 million, $12.8 million). Heart valve surgery accounted for 28% of admissions and 71% of the cost. For children 5–14 years of age, valve surgery accounted for 7% of admissions and 27% of the cost. Two‐thirds of the cost occurs after the age of 30. Conclusions: ARF and RHD comprise a burden of mortality and hospital cost concentrated largely in middle age. Māori and Pacific RHD mortality rates are substantially higher than those of non‐Māori/Pacific.     

357例风湿热和风湿性心脏瓣膜病30年临床变迁

目的 探讨30年来风湿热和风湿性心脏瓣膜病(风心病)的发病特点及规律，为临床提供诊断和治疗依据。方法 对我科1972～2002年357例风湿热及风心病住院患儿的流行病学、临床表现、实验室检查、并发症及预后进行回顾性分析。结果 儿童风湿热和风心病住院人数有增加趋势，但其在流行病学方面改变不大。结论 30年来风湿热的发病及严重程度未下降，1992年修订的Jones标准有待进一步完善。     

Rheumatic fever and rheumatic heart disease in children in North India

Summary Data on 118 cases of rheumatic fever and rheumatic heart disease in the age group of 4–14 years are reported. 52.8% gave a past history of rheumatic fever or rheumatic heart disease. 72% cases showed evidence of rheumatie activity. Carditis was the commonest lesion seen in 71% patients. 56.8% cases were in congestive heart failure. Chorea and subcutaneous nodules were seen in 17.8% and 16.1% respectively—far more frequent than generally believed in our country. The presence of subcutaneous nodules without cardiac involvement and of arthritis or arthralgia in association with chorea seen in some children are reported. From the Department of Paediatrics and Cardiology, Post-graduate Institute of Medical Education and Research, Chandigarh-11.     

Primary preventive health care in children with heart disease

Summary In order to evaluate the preventive health care practices in children with heart disease, 499 families were surveyed in outpatient settings. Data were collected on 215 children with heart disease and 284 control children without known chronic illness. There was no significant difference between the groups in the type of primary physician utilized or frequency of visits to the primary care physician. Immunizations were incomplete in 32.7% of the children with heart disease compared to only 2.5% in the control group (P<0.0001). Among the children over 3 years of age with heart disease, 29% had not received routine dental care within the past year compared with 23.4% in the controls (P=NS). The parents of children with heart disease were found to pay less money out-of-pocket for their child's health care than the parents of control children (P<0.0001). The data suggest that important aspects of primary health care were neglected in a large group of children with heart disease and that cost was not a major cause for the inadequate preventive care delivery. An educational program directed at health care professionals and parents is proposed.     

儿童不明原因发热357例病因及临床特征分析

目的探讨儿童不明原因发热的病因分布及临床特征, 为儿童不明原因发热的早期诊断提供线索。方法收集2016年1月1日至2020年12月31日复旦大学附属儿科医院357例不明原因发热患儿的病因构成、年龄、性别、病程、住院时间、确诊时间及急性期的炎症因子水平等临床资料行病例对照分析。依据疾病种类分为感染性疾病组(简称感染组)、非感染性炎症性疾病组(简称非感染组)、肿瘤性疾病组(简称肿瘤组)和其他疾病组(简称其他组)。依据年龄分为<1岁组, 1～<3岁组、3～<6岁组、6～<12岁组及12～<18岁组, 组间比较采用Mann-WhitneyU检验、Kruskal-WallisH检验和χ2检验。结果 357例患儿中男217例、女140例, 就诊年龄5.1(2.0, 9.3)岁, 起病年龄3.9(1.3, 9.2)岁, 确诊时间94(66, 213)d, 住院时间8(6, 14)d。感染组163例(45.7%)、非感染组133例(37.2%)、肿瘤组21例(5.9%), 其他组40例(11.2%), 4组间起病年龄差异有统计意义(H=94.01, P<0.01),...