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思考病例廿四的最后诊断为风湿性心脏病二尖瓣左瓣狭窄伴闭锁不全、主动脉瓣闭锁不全,并发主动脉瓣左瓣细菌性心内膜炎。大部分参加讨论的同志在来稿(答案)中均提及以上诊断,有的经过排除诊断,排除了其他可能,最终得到正确的诊断。但有的同志多考虑了某些稀见病如系统性红斑狼疮、结节病、血液系统疾病等。本例的临床表现对感染性心内膜炎的诊断是有利的。如病史中记载有不规则发热、心脏杂音、贫血、白细胞增高、γ球蛋白增高,尿中有蛋白、管型,激素治疗无效等。不能根据皮肤无栓塞症状或血培养阴
The final diagnosis of case 24 was rheumatic heart disease with mitral valve stenosis and left atrial septal insufficiency, aortic valve insufficiency, complicated with aortic valve lobe bacterial endocarditis. Most of the comrades participating in the discussion referred to the above diagnosis in the manuscript (answer), some ruled out the diagnosis, ruled out other possibilities, and finally got the correct diagnosis. However, some comrades have considered some rare diseases such as systemic lupus erythematosus, sarcoidosis and blood system diseases. The clinical presentation of this case is favorable for the diagnosis of infective endocarditis. As recorded in the history of irregular fever, heart murmur, anemia, leukocytosis, increased gamma globulin, urinary protein, tubular, hormone therapy and so on. Not according to the skin without embolism or blood culture Yin