Clinical Retrospective Analysis On Rheymatic Fever And Rheymatic Heart Disease

Objective:The incidence of acute rheumatic fever and rheumatic heart disease is declining from 1950 s because of the widely using of penicillin. Recently, incidence of them has been increasing, and the clinical manifestations become more and more atypical. By analyzing the clinical data of 70 children who were diagnosed and hospitalized in Children’s Hospital of Chongqing Medical University, we classified the 70 children into two groups as typical group and atypical group,and summarized the clinical features and auxiliary examinations to provide guidance for early recognition and appropriate treatment of ARF/RHD.Methods:We collected 70 children of ARF/RHD who were diagnosed and hospitalized in Children’s Hospital of Chongqing Medical University from June 2000 to Dec 2014. To describe retrospectively features we divided the 70 children into typical group(37 cases) and atypical group(33 cases) according to the clinical manifestations typical or not. Using SPSS 19.0 for the statistical analysis.Results:1.The age of all the patients’ are 5y4m-16y10 m, most is 10-15 y. Male is higher than female, rural is higher than urban,it is more prevalent in winter and spring, but also can happen at any seasons.2.In a total of 70 patients, 85.7% Patients had prodromes,the most common symptom was upper respiratory tract infection in the two groups. Carditis are the first symptoms in the 70 patients. In the typical group is Arthralgia(54.0%), and the atypical group is carditis(81.8%).3.There were high incidence of carditis in two groups, and no significant difference between two groups(P>0.05). The incidence of multiple arthritis、multiple with carditis、fever and arthralgia of typical group was significantly higher than atypical group(P<0.05). The incidences of chorea、subcutaneous nodules、erythema marginatum were less than 10%,there’s no significant difference between two groups(P>0.05).4.The most common complication in typical group was arrhythmia, and there’s no significant difference between two groups(P>0.05). And the heart failure was the most common complication of atypical group, atypical group was significantly higher than typical group(P<0.05). The incidence of infective endocarditis、acute pulmonary edema、acute kidney damage of atypical was also significantly higher than typical group(P<0.05).5.There were high incidence of the positive rate of ESR and no significant difference in two groups(P>0.05). The Positive rate of CRP、GAS and ASO of typical group was significantly higher than atypical group(P<0.05).6.There were high incidence of the positive rate of ECG, and the sinus tachycardia was the most common result, There’s no significant difference in two groups(P>0.05). ST-T of atypical group was significantly higher than typical group(P<0.05). The QT in two group was no significantly different, the incidence was similar with PRc.7.According to the UCG, the incidence of severe valvular regurgitation and pericardial effusion of atypical group were significantly higher than typical group(P<0.05).8. Penicillin was the first chioce to anti-streptococcal infections. Aspirin and naproxen had a good effect on arthritis. Using glucocorticoids impact therapy in severe acute left heart failure can quickly and Significantly improve cardiac function.Conclusions:The cardiacs is the major manifestation of pediatrac atypical acute theumatic fever when patients go to the hospital first. There is higher incidence of complications such as heart failure、cardiogenic shockin、infective endocarditis and other organs damages in the atypical ARF, and most atypical ARF patients also have severe valvular diseases. Atypical ARF severely impact on the health and the quality of life of children, which needs to Strengthen diagnosis of atypical ARF/RHD.