CAJ | 학술논문

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卜慢性咽炎病史者1126例,从中筛选抗链球菌溶血素O(ASO)在400-500 U/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T酶(CK-MB)、超声心动图.因各种类型心脏瓣膜病变的例数较少,只能列表;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400 U/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400～500 U/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.
목적 탐토장기만성인염여무증상풍습활동인기풍습성심장병적관계,료해무증상풍습활동인기풍습성심장판막병적점진성병정.방법 자1986년개시,종체검자중선취유반년이복만성인염병사자1126례,종중사선항련구균용혈소O(ASO)재400-500 U/ml,무명학풍습열병사화림상표현자319례수방관찰,남성158례,녀성161례,년령14～35세,평균29.4세.지본차통계시간,실방6례,수집도313례수방자료,남성155례,녀성158례,년령35～55세,평균49.6세.수방기간매년검측1차ASO、기산격매동T매(CK-MB)、초성심동도.인각충류형심장판막병변적례수교소,지능렬표;발생판막병변자여미발생판막병변자지간ASO화CK-MB적비교채용t검험.결과 ①313례중9례재수방제4년내환전형풍습열.29례우수방제1,2혹제3년후ASO지속저우400 U/ml자,재차후적수방중유1례검출이첨판증후.②275례ASO장기재400～500 U/ml,차CK-MB장기재정상고한자,수방제5、10、15、20년시분별유9,42、65、78례발생판막병변.③유판막병변자.추근우상한적CK-MB명현고우무판막병변자(P<0.05).단ASO수평차이무통계학의의(p>0.05).결론 ASO,CK-MB지속재정상고한적장기만성인염환자중,부분환자재평시적생활과정중장기존재무증상풍습활동,병가유차도치풍습성심장판막병.
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 cases 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 ①Of the 313 cases, 9 cases suffered from rheumatic fever at the fourth year since 1986, and 29 cases 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.②Two 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.