急性风湿病合并二尖瓣脱垂10例报告

PATIENTS OF ACUTE RHEUMATISM ASSOCIATED WITH MITRAL VALVE PROLAPSE

本文报告１０例急性风湿病合并二尖瓣脱垂。主要临床表现为急性风湿病的特点，但病情重，心力衰竭难以控制，心尖部可以闻及收缩中、晚期喀喇音，二维超声心动图和（或）彩色多普勒血流显像显示收缩期二尖瓣一叶或两叶脱入左房。经抗风湿、强心治疗，心功能不全得到纠正，二尖瓣反流减轻。随访２月～５年（平均１４．４月），１例自动出院并死于心力衰竭，３例分别在病程的１２、１５、２４个月时收缩中、晚期喀喇音消失，二维超声心动图复查二尖瓣叶活动恢复正常，余６例病程仅２～４个月，尚在随访之中，随时问推移，也可能恢复正常。文中就急性风湿病继发二尖瓣脱垂的机制进行了讨论。提示炎症性瓣叶脱垂的存在，而且可能是可逆的。

Ten patients of acute rheumatism associated with mitral valve prolapse were studied. Clinical manifestations were of characteristic acute rheumatism with congestive heart failure hard to control. Moderate end systolic murmur could be heard over the apex area.Two-dimensional and /or pulse Doppler echocardiography showed prolapse of one or two cusps of the mitral valve into the left atrium during systole. After treated by anti-rheumatic and inotropic agents, cardiac dysfunction was corrected and mitral regurgitation reduced. In a mean follow-up period of 14. 4 months (2～5 yrs), one patient refused to stay in the hospital died of congestive heart failure, cusp movement in three patients recovered in 10, 15 and 24 months, the other patients with illness of 2～4 months were still on follow-up. The results suggest the presence of inflammatory valve prolapse which is reversible on treatment.