CAJ | 학술논문

目的探讨近十年风湿热临床表现及实验室榆查的变化,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.
목적 탐토근십년풍습열림상표현급실험실유사적변화,위진단급치료제공삼고.방법 수집아원풍습열환자공315례,분위2조,1985-1995년취진적위A조,1997-2007년취진적위B조,비교2조적림상표현급실험실검사.결과 남:녀위1:2.심장염、다관절염잉시최상견적증상.여A조비교,B조저열、심장염증가,심력쇠갈감소,C반응단백(CRP)、항련구균용혈소O(ASO)양성솔하강.B조적Jones진단표준(1992)부합솔위61.4%,2002-2003년세계위생조직(WHO)진단표준적부합솔위76.4%.제시풍습성심장염진단,림파세포촉응혈활성(PCA)적민감성화특이성분별위79.1%화71.4%,A조련구균다당항체(ASP)적민감성화특이성분별위70.3%화70%.B조35례수방료5～10년적환자풍습열복발솔위62.8%,부1/3진행료규범이급예방,기복발솔명현저우무규범이급예방적환자.결론 근십년경증심장염증가;PCA、ASP제시풍습성심장염개치교대;응경가주의불전형병례적진단급가강이급예방.
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. Results 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. 1997. 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 earditis 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.