摘要
目的总结儿童风湿热的临床特点。方法回顾性分析2006年6月至2016年6月于首都医科大学附属北京儿童医院诊断为风湿热的99例住院患儿的临床资料。结果患儿年龄4岁7个月至16岁2个月,男女比2.3∶1。临床表现最常见为发热,其次为风湿性心脏病,之后为风湿性关节炎、舞蹈症,最少见的为环形红斑及皮下小结。实验室检查中抗链球菌溶血素O(anti-streptolysin O, ASO)升高发生率为76.8%,发热患儿较不发热患儿ASO升高更常见(χ2=3.9,P=0.048)。WBC升高36例(36.4%),CRP升高33例(33.3%),ESR增快47例(47.5%),此3项检查敏感性及特异性并不高。ECG、超声心动图、心脏听诊的检查阳性率分别为62.6%、45.5%、30.3%。ECG检查的敏感性较高,但特异性不高,超声心动图的敏感性及特异性均较高。99例患儿中入院前使用青霉素的仅18例(18.2%)。使用抗菌药物组ASO升高率及关节炎发病率与未使用抗菌药物组的差异无统计学意义(P>0.05)。结论风湿热临床表现多不典型,临床医生接诊此类患儿时需要结合临床症状及实验室检查综合判断。
Objective To summarize the clinical characteristics of children with rheumatic fever.Methods The clinical data of children with rheumatic fever in Beijing Children’s Hospital from 2006 to 2016 were retrospective analyzed.Re?sults The age of the patients was 4 to 16 years old,the ratio of male to female was 2.3∶1.The common clinical manifestations of rheumatic fever were fever,rheumatic heart disease,rheumatoid arthritis,and chorea,the minimal clinical manifestations were ring erythema and subcutaneous nodules.The incidence of ASO elevation was 76.8%,and ASO elevation was more common in the patients with fever than the patients with no fever(χ^2=3.9,P=0.048).In this study,WBC increased in36 patients(36.4%),CRP increased in 33 patients(33.3%),ESR increased in 47 patients(47.5%).The three tests had lower sensitivity and specificity.The positive rates of ECG,cardiac Doppler ultrasonography and cardiac auscultation in 99 patients with rheumatic fever were 62.6%,45.5%,and 30.3%,respectively.The sensitivity of ECG was higher,but the specificity was lower.Cardiac Doppler ultrasonography was more sensitive and specific for rheumatic heart disease.Only 18.2%of the patients had used penicillin before admission.There were no significant differences in the rate of ASO and the incidence of arthritis between the antibiotic group and the non-antibiotic group.Conclusions The clinical manifestations of rheumatic fever are atypical,and clinicians need to make comprehensive judgment based on clinical symptoms and laboratory examination results.
作者
高路
林利
赵智慧
袁越
Gao Lu;Lin Li;Zhao Zhihui;Yuan Yue(Department of Cardiology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)
出处
《北京医学》
CAS
2019年第1期38-41,共4页
Beijing Medical Journal
关键词
风湿热
临床特征
rheumatic fever
clinical characteristic
