风湿性心脏病的临床和病理比较分析

A Clinical and Pathogical Study of 111 Cases of Rheumatic Heart Diseases

目的：探讨风湿性心脏病（风心病）风湿活动的现状和提高对该病的认识。 方法：回顾性研究１１１例风心病瓣膜置换手术前后临床资料和术后瓣胰活检结果。 结果：①病理出现Ⅱ期改变者１６例（１４．４％）；参考“可能风湿热”的标准，３１例近期曾有风湿活动者术后病理呈Ⅱ期改变（３５．５ ％），高于近期无风湿活动呈Ⅱ期改变（６．２５ ％）（Ｐ＜０．０１）；②术前抗链球菌溶血素“Ｏ”、血沉增高者中呈Ⅱ期改变与术前抗链球菌溶血素“Ｏ”、血沉正常者呈Ⅱ期改变比较，两者差别无统计学意义。 结论：风心病常伴有风湿活动。常规实验室检查（血沉、抗链球菌溶血素“Ｏ”）不能反映风湿是否存在活动；应用“可能风湿热”的标准判断风心病风湿活动有较高的临床实用价值。

Objective: To investigate present situation of rheumatic activity in rheumatic heart disease (RHD). Methods: One hundred and eleven patients with valve replacement were included in this study. Clincal and pathological data were reviewed retrospectively. Results: ①pathological examination of heart valves and left auricle in there patients showed that 16 cases (14.4% )of them had pathological period Ⅱ change. Refered to 'possible rheumatic fever' standard, 31 cases were judged as having rheumatic activity recently, and 35 .5% of them had pathological period Ⅱ change. It was higher than that (6 .25% )in the patients who were not judged rheumatic activity (p = 0.000). ② Comparing the percentage of pathologicla period Ⅱchange in patients with elevated antistreptolysin-O (ASO) or erythrocyte sedimentation rate (ESR) with that in patients with normal ASO or ESR before operation, we can not consider that the difference had statistic significance (p =0.052 and 0.556). Conclusion: ① RHD often accompanies with rheumatic activity. Routine laboratory examination (ESR, ASO) does not indicate that the rheumatic activity is present or not. ② It has clinical practical value to apply 'possible rheumatic fever' standard in judgement of RHD with rheumatic activity.