急性风湿性心脏瓣膜炎临床特点分析

Clinical characteristics of acute rheumatic valvulitis

目的:分析急性风湿性心脏瓣膜炎的临床特点及实验室检查,以改善预后指导临床。方法:纳入2016年1月至2019年12月,在首都医科大学附属北京儿童医院,符合研究标准且诊断为风湿热的患儿103例,其中有心脏瓣膜损害并诊断为急性风湿性心脏瓣膜炎的患儿78例,没有心脏瓣膜损害的风湿热患儿25例作为对照组。回顾性分析两组临床特点、实验室检查、心脏彩超检查情况及心电图检查情况。结果:与对照组比较,急性风湿性心脏瓣膜炎组平均年龄较大[(10.0±2.1)vs.(9.0±2.6)岁,t=2.01,P<0.05],心脏炎发生率(100%vs.48%,χ^2=46.42,P<0.05)及舞蹈病发生率(14.1%vs.零,χ^2=3.95,P<0.05)较高,LDH水平[237.5(205.0,281.0)vs.205.0(180.5,226.0)U/L,Z=-2.473,P<0.05]较高,LVEF[(66.87±6.27)%vs.(69.64±3.65)%,t=-0.21,P<0.05]较低,LVEDD[(46.3±5.8)vs.(40.4±5.1)mm,t=4.5,P<0.05]较大,PR间期延长比例(32.1%vs.12.0%,χ^2=5.328,P<0.05)较多。最常见的瓣膜病变为二尖瓣反流,共66例(84.6%),其次为主动脉瓣反流49例(62.8%),再次为三尖瓣反流46例(59.0%),肺动脉瓣反流4例(5.9%),二尖瓣脱垂3例(3.8%),主动脉瓣脱垂2例(2.6%)。未发现瓣膜狭窄患儿。结论:急性风湿性心脏瓣膜炎患儿年龄较大,心脏炎及舞蹈病发生率较高,LDH水平较高,LVEF较低,LVEDD,PR间期延长患儿较多,二尖瓣反流为最常见的瓣膜病变。

Objective:To analyze the clinical characteristics and laboratory examination of acute rheu-matic valvulitis so as to improve the prognosis and guide the clinical practice.Methods:From January 2016 to December 2019,103 children with rheumatic fever in Beijing Children's Hospital Affiliated to Capital Medical University were included in this study,including 78 children with heart valve damage and diagnosed as acute rheumatic valvulitis,and 25 children with rheumatic fever without heart valve damage as the control group.The clinical characteristics,laboratory examination,color Doppler echocardiography and ECG of the two groups were analyzed retrospectively.Results:Compared with the control group,the age[(10.0±2.1)vs.(9.0±2.6)years,t=2.01,P<0.05]of children with acute rheumatic valvulitis was higher,the incidence of carditis(100%vs.48%,χ^2=46.42,P<0.05)and chorea(14.1%vs.zero,χ^2=3.95,P<0.05)were higher,LDH[237.5(205.0,281.0)vs.205.0(180.5,226.0)U/L,Z=-2.473,P<0.05]were higher,left ventricular ejection fraction[(66.87±6.27)%vs.(69.64±3.65)%,t=-0.21,P<0.05]were lower,left ventricular end diastolic diameter[(46.3±5.8)vs.(40.4±5.1)mm,t=4.5,P<0.05]were larger,PR interval prolongation ratio(32.1%vs.12.0%,χ^2=5.328,P<0.05)were more.The most common valvular disease was mitral regurgitation,66 cases(84.6%),followed by aortic regurgitation 49 cases(62.8%),tricuspid regurgitation 46 cases(59.0%),4 cases of pulmonary valve reflux(5.9%),3 cases of mitral valve prolapse(3.8%),and 2 cases of aortic valve prolapse(2.6%).There are no children with valve stenosis.Conclusions:children with acute rheumatic valvulitis are older,have higher incidence of carditis and chorea,higher LDH level,lower LVEF,larger LVEDD,longer PR interval,and mitral regurgitation is the most common valve disease.