以急性心力衰竭为首发症状的儿童风湿性心脏炎10例临床分析  

Acute heart failure as an initial symptom of pediatric rheumatic carditis:clinical analysis of 10 cases

作　　者：刘麟[1] 欧振恒 谭卫群[1] 刘艳华 李博宁[1] 刘琮[1] Liu Lin;Ou Zhenheng;Tan Weiqun;Liu Yanhua;Li Boning;Liu Cong(Department of Pediatric Cardiology,Shenzhen Children′s Hospital,Shenzhen 518026,China)

机构地区：[1]深圳市儿童医院心血管内科,深圳518026

出　　处：《中华实用儿科临床杂志》2022年第21期1669-1673,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨以急性心力衰竭为首发症状的儿童风湿性心脏炎的临床表现、病变特点和治疗预后,以提高临床医师对该病的认识。方法回顾性分析2015年1月至2022年2月深圳市儿童医院收治的10例以急性心力衰竭为首发症状的急性风湿性心脏炎患儿的临床资料、实验室检查以及影像资料和诊治预后资料。结果10例患儿男4例,女6例,平均就诊年龄9.1岁(3岁1个月~11岁3个月),起病时间(9.3±3.2)d(4~14 d)。10例患儿病程初期除心脏症状外,4例有关节症状,3例有神经系统症状,2例有皮肤症状。超声心动图示患儿均有二尖瓣病变,其中复合瓣膜病变5例,单纯二尖瓣关闭不全3例,二尖瓣联合病变(二尖瓣关闭不全伴二尖瓣狭窄)2例。所有患儿经抗风湿、抗感染和抗心力衰竭治疗后心功能改善,瓣膜病变减轻。随访6个月~6年,6例遗留慢性风湿性心脏瓣膜病。结论以急性心力衰竭为首发症状的风湿性心脏炎临床发病早,有典型的风湿热表现,主要病变为二尖瓣病变,超声心动图有助于早期诊断。内科治疗有效,但风湿性心脏瓣膜病后遗症发生率较高。Objective To investigate the clinical manifestations,pathological characteristics,treatment and prognosis of pediatric rheumatic carditis with the initial symptom of acute heart failure,and to improve the clinical understanding of the disease.Methods The clinical data,laboratory examination results,imaging findings,treatment and prognosis data of 10 cases with acute rheumatic carditis were collected and analyzed retrospectively.The patients pre-sented with acute heart failure as the first symptom and were treated in Shenzhen Children′s Hospital from January 2015 to February 2022.Results There were 4 males and 6 females in this study.The mean age was 9.1 years(3 years and 1 month to 11 years and 3 months),and the average onset age was(9.3±3.2)days(4-14 days).All the 10 cases had circulation symptoms.Besides,4 cases were also complicated with joint symptoms,3 cases with neurological symptoms and 2 cases with skin symptoms.Echocardiography revealed mitral valve diseases in all cases.More specifically,combined valve diseases were found in 5 cases,pure mitral regurgitation in 3 cases,and mixed mitral valve diseases(mitral regurgitation complicated with mitral stenosis)in 2 cases.After receiving antibiotic therapy,anti-infection treatment and anti-heart failure therapy,symptoms improved in all patients and valve lesions were alleviated.All patients were followed up for 6 months to 6 years.Six cases had persistent rheumatic heart disease during the follow up.Conclusions Pediatric rheumatic carditis with the initial symptom of acute heart failure is characterized by early onset and the typical manifestation of rheumatic fever.Mitral valve disease is the commonest lesion.Echocardiography is of great value for the early diagnosis of the disease.Medical treatment is effective,but the incidence of chronic rheumatic heart disease is still high.

关 键 词：风湿热 心脏炎 风湿性心脏病 二尖瓣关闭不全 心力衰竭 

分 类 号：R725.4[医药卫生—儿科]