风湿性心脏病患者风湿热复发的诊断探讨

为探讨风湿性心脏病（ＲＨＤ）患者风湿热复发（ＲＡＲＦ）的诊断，选择具２年以上病程的ＲＨＤ患者和２次超声心动图检查且本次检查显示心脏瓣膜病变比２年前有明显加重的９７例病人，认为ＲＡＲＦ的诊断条件是：在新近Ａ组链球菌感染基础上，ＲＨＤ患者具有Ｊｏｎｅｓ标准一项主要表现，或缺乏主要表现而具备次要表现五项中之两项以上者即可诊断为ＲＡＲＦ。若仅具备次要表现一项，并伴有贫血、腹痛、鼻衄、心前区隐痛等症状两项和具有ＩｇＧ、ＩｇＡ、循环免疫复合物，血清补体Ｃ＿３值增高一项以上者，若能排出其他原因，亦可认为有ＲＡＲＦ之可能性。

AN APPROACH TO THE DIAGNOSIS OF RECURRENT ATTACK OF RHEUMATIC FEVER IN PA- IENTS WITH RHEUNATIC HEART DISEASE

In order to evaluate recurrent attack of rheumatic fever(RARF)in patients with rheumatic heart dis-ease(RHD),97 patients with diagnosis of RHD for two years and more were included in this study.Pro- gression of the lesions of cardiac valves was found in every case by comparing the echocardiographic and Doppler findings at present and two years ago. The history of the initial attack of acute rheumatic fever or the appearance of RHD were reviewed. The present complaints at admission and necessary laboratory pro-ceedures were studied. The data showed that 75 of the 97 patients had history of initial attack of ARF and the remaining 22 were symptomless with indolent carditis or carditis of insidious onset two years ago. In this admission,only 25 of the 97 patients had ARF if the Jones criteria were followed strictly,while the remaining 72 did not fulfill the criteria,It is suggested that if there is evidence of recent group a streptococ- cal infection,the conditions for diagnosis of RARF are as follows:(1)When one major or more than two minor criteria are present in a patient with RHD,a definite diagnosis of RARF may be made.(2) A pre- sumptive diagnosis of RARF may be made,when a patient presents one minor criteria and several other manifestations such as anemia,abdominal pain,rapid sleeping pulse rate,tachycardia out of proportion to fever,malaise, epistaxis,precordial pain and an elevated level of lgG,IgA,C_3 and circulating immune complexes.