近十年风湿热的演变

Feature changes of rheumatic fever in last ten years

目的探讨近十年风湿热临床表现及实验室检查的变化，为诊断及治疗提供参考。方法收集我院风湿热患者共315例，分为2组，1985—1995年就诊的为A组，1997-2007年就诊的为B组，比较2组的临床表现及实验室检查。结果男：女为1：2。心脏炎、多关节炎仍是最常见的症状。与A组比较，B组低热、心脏炎增加，心力衰竭减少，C反应蛋白（CRP）、抗链球菌溶血素O（ASO）阳性率下降。B组的Jones诊断标准（1992）符合率为61．4％，2002-2003年世界卫生组织（WHO）诊断标准的符合率为76．4％。提示风湿性心脏炎诊断，淋巴细胞促凝血活性（PCA）的敏感性和特异性分别为79．1％和71．4％，A组链球菌多糖抗体（ASP）的敏感性和特异性分别为70．3％和70％。B组35例随访了5～10年的患者风湿热复发率为62．8％，仅1／3进行了规范二级预防，其复发率明显低于无规范二级预防的患者。结论近十年轻症心脏炎增加；PCA、ASP提示风湿性心脏炎价值较大；应更加注意不典型病例的诊断及加强二级预防。

Objective To investigate the changes of clinical and laboratory manifestations of rheumatic fever （RF） in recent ten years by reviewing the medical data of 315 patients with RF. Methods Three hundred and fifteen in-patients and out-patients with RF during 1985-1995 （group A） and 1997- 2007（group B） were selected. Their manifestations were compared. Nesults Male/female ratio was about 1：2. Carditis and polyarthritis were common manifestations. Compared with group A, the rate of low-grade fever and carditis increased and the rate of heart failure, positive rate of C reaction protein and antistreptolysin O decreased in group B. In group B, 61.4% patients fulfilled the updated Jones diagnostic criteria. 76.2% fulfilled the 2002-2003 WHO criteria. The sensitivity and specificity of peripheral blood lymphocyte procoagulant activity （PCA） for the diagnosis of rheumatic carditis was 79.1% and 71.4% respectively. That of the anti-streptococcal group A polysaccharide （ASP） antibodies was 70.3% and 70% respectively. Five to ten years follow-up clinical data were available for 35 cases since Dec. 199.7. The recurrent rate of RF was 62.8%. Only 1/3 cases received regular secondary prevention. Recurrence rate of patients with regular secondary prevention was significantly lower than that of patients without regular secondary prevention. Conclusion Mild carditis has been increasing during last ten years. PCA and ASP are valuable tests for diagnosing rheumatic carditis. More emphasis should be paid to atypical cases, early diagnosis and regular secondary prevention in order to improve prognosis.