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1.本文报告成人急性风湿热366例,經住院观察的急性发作共415次,其中102次診断为初发,313次为复发。发作見于已有慢性心瓣缺损者計184例(218次发作),无心瓣缺损証据者182例(197次发作)。对发病季节、与溶血性鏈球菌感染的关系、临床表現、实验室发見、病程及病死率等作了分析。重点討論了本病的診断问題。 2.风湿热在春冬二季的发病率較高,41％的风湿发作前有咽痛,58.6％的风湿发作时咽部尚有炎症表現,仅24.7％的风湿发作前后均无咽炎的証据。約有80％发作中抗鏈球菌溶血素“O”滴定度在250单位以上。以上数字有力地說明了风湿热和鏈球菌感染之间的密切关系。 3.临床表現中以关节炎最为常見,发生率为55.7％,仅有关节酸痛的有30％。已有慢性心瓣缺损的病例中仅37.6％有关节炎,其发生率远低于无慢性心瓣缺损的病例(75.6％)。 4.心炎見于49.9％的发作中,其临床表現有时颇不明显。仅在心电图檢查中发見者有41例,占所有經过心电图檢查的心炎病例的29％。由此可見心电图检查对診断心炎的独特价值。 5.在曾作心电图檢查的250次发作中有82次(32.8％)发見房窒傳导阻滞,其中68次为P-R间期延长。作者等认为,P-R间期延长或更高度的房室傳导阻滞,若发見于有鏈球菌感染之后的年青患者,应作为急性风湿性心炎的診断依据之一。 6.在已有慢性心瓣病的病例中,有38.5％得根据Jones氏診断标准中的几項次要表現而診断为风湿活动。 7.366例中58.5％有风湿热的复发,其中半数发生子初发以后的第一年內。住院期的当时病死率为6.5％。
1. This article reports 366 cases of adult acute rheumatic fever, the acute attack of hospitalized observation of a total of 415 times, of which 102 were diagnosed as initial and 313 as recurrence. Seizures were found in 184 (218 episodes) of patients with chronic heart valve defects and 182 (197 episodes) of evidence of no heart valve defects. The onset season, the relationship with hemolytic streptococcus infection, clinical manifestations, laboratory findings, disease duration and mortality were analyzed. Focus on the diagnosis of the disease. 2. The incidence of rheumatic fever in the spring and winter season is higher, 41% before the onset of rheumatism sore throat, 58.6% of the rheumatoid rheumatism is still the performance of the throat, only 24.7% of the rheumatoid episode before and after no pharyngitis evidence . About 80% of seizures in the anti-streptolysin “O” titer of 250 units or more. The above figures provide a powerful illustration of the close relationship between rheumatic fever and streptococcal infection. 3. The most common clinical manifestations of arthritis, the incidence was 55.7%, only 30% of joint pain. Only 37.6% of patients with chronic heart valve defects had arthritis, with a much lower incidence than those without chronic heart valve defects (75.6%). 4. Heart inflammation seen in 49.9% of the episodes, the clinical manifestations are sometimes quite obvious. In the electrocardiogram, only 41 were found, accounting for 29% of all cases of cardiac inflammation after electrocardiographic examination. This shows the unique value of ECG diagnosis of myocarditis. In 82 electrocardiographic examinations (82.8%), atrial septal block was observed in 82 out of 250 seizures, of which 68 were prolonged P-R intervals. The authors believe that prolonged P-R or more atrioventricular block, if found in patients with young streptococcal infection, should be used as a diagnosis of acute rheumatic carditis basis. 6. Of the cases with chronic heart valve disease, 38.5% had rheumatic activity diagnosed on the basis of several secondary manifestations of Jones’s diagnostic criteria. Of the 7.366 cases, 58.5% had recurrence of rheumatic fever, of which half occurred within the first year after the onset of the child. At the time of hospitalization, the case fatality rate was 6.5%.