长期慢性咽炎与无症状风湿活动导致风湿性心脏瓣膜病的20年随访研究

A 20-year follow-up study on the correlation between long-term chronic pharyngitis and rheumatic heart vavular disease caused by latent chronic rheumatic activity

目的探讨长期慢性咽炎与无症状风湿活动引起风湿性心脏病的关系，了解无症状风湿活动引起风湿性心脏瓣膜病的渐进性病程。方法自1986年开始，从体检者中选取有半年以上慢性咽炎病史者1126例，从中筛选抗链球菌溶血素O（ASO）在400～500U／ml，无明确风湿热病史和临床表现者319例随访观察，男性158例，女性161例，年龄14～35岁，平均29．4岁。至本次统计时间，失访6例，收集到313例随访资料，男性155例，女．性158例，年龄35～55岁，平均49．6岁。随访期间每年检测1次ASO、肌酸激酶同工酶（CK—MB）、超声心动图。因各种类型心脏瓣膜病变的例数较少，只能歹U表；发生瓣膜病变者与未发生瓣膜病变者之间ASO和CK—MB的比较采用t检验。结果①313例中9例在随访第4年内患典型风湿热。29例于随访第1，2或第3年后ASO持续低于400U／ml者，在此后的随访中有1例检出二尖瓣增厚。②275例ASO长期在400～500U/ml，且CK—MB长期在正常高限者，随访第5、10、15、20年时分别有9、42、65、78例发生瓣膜病变。③有瓣膜病变者，趋近于上限的CK—MB明显高于无瓣膜病变者（P〈0．05），但ASO水平差异无统计学意义（P〉0．05）。结论ASO，CK—MB持续在正常高限的长期慢性咽炎患者中，部分患者在平时的生活过程中长期存在无症状风湿活动，并可由此导致风湿性心脏瓣膜病。

Objective To observe the correlation between long-term chronic pharyngitis and rheumatic heart vavular disease （RHD） caused by to long-term latent chronic rheumatic activity and to understand the progressive course of rheumatic heart vavular disease. Methods In 1126 cases with chronic pharyngitis, 319 eases with serum antistreptolysin O （ASO） level between 400-500 U/ml were followed-up. ASO, creatine kinase enzyme MB （CK-MB） and echocardiography were measured for follow-up since 1986. Of the 319 cases, 158 were male and 161 were female with the average age of 29.4 years old. By the end of 2009, 6 cases were lost during follow up, data of 313 cases including 155 male patients and 158 female patients whose average age was 49.6 were analyzed. As the number of every kind of rheumatic heart vavular lesion was so fewer for statistical analysis that the data were only listed in tables. The student＇s t test was performed to compare of the ASO, CK-MB between the group with vavular lesionss and the group without vavular lesion. Results （1） Of the 313 cases, 9 cases suffered from rheumatic fever at the fourth year since 1986, and 29 eases had rheumatic fever 1, 2 or 3 years after the ASOs decreased to lower than 400 U/ml and no one developed heart valvular lesion. （2） Two hundred and seventy-five cases whose ASO in the range of 400-500 U/ml but with normal CK-MB were found by the end of 5, 10, 15, 20 years, 9, 42, 65, 78 cases had developed heart vavular diseases respectively. （3） The levels of CK-MB in the heart valvular disease groups were significantly higher than those in the non-vavular disease group, while the levels of ASO were not. Conclusion Some of the cases suffering from long-term chronic pharyngitis can have high levels of ASO, but with normal CK-MB. These patients may have latent long-term chronic rheumatic activity and develop rheumatic heart valvular disease years later.