儿科医学课件：风湿热

Rheumatic fever Understand the etiology and pathologic features of rheumatic fever.Master the clinical manifestations and diagnostic criterion of rheumatic fever.Master the treatment and preventive methods of rheumatic fever.Purpose and RequirementOutline Rheumatic fever is closely related to infection with group A-hemolytic streptococci.Rheumatic fever is most frequently observed in children from 515 year of age.Two immune reaction anaphylaxis(变态反应变态反应)auto-immune reaction（自身自身免疫反应）免疫反应）Pathogenesis 问题？A组乙型溶血性链球菌感染可组乙型溶血性链球菌感染可诱发风湿热已被公认，但在众多诱发风湿热已被公认，但在众多的的A组乙型溶血性链球菌感染中组乙型溶血性链球菌感染中为什么只有少数人（为什么只有少数人（0.3%3%）发生本病？发生本病？EtiologyThe strain of infecting organism（感染的菌株）感染的菌株）Heredity susceptibility of host（宿主的遗传易感性）宿主的遗传易感性）Socioeconomic status、weather（社会经济状况、气候）社会经济状况、气候）PathologyProcess of pathology were divide into three stages:Exudation（渗出期）、渗出期）、proliferation（增殖期）、增殖期）、sclerosis（硬化硬化期）期）.but pathological changes of each stage can exist at the sametime.Basic pathological changes are inflammation and characteristic“aschoff bodies”（风湿小体）风湿小体）.Clinical Manifestations Fever Carditis（心脏炎）心脏炎）Polyarthritis（多发性关节炎）多发性关节炎）Erythema marginatum（环形红斑）环形红斑）Subcutaneous nodules（皮下结节）皮下结节）Chorea（舞蹈病）舞蹈病）l1.过去未有的器质性杂音l2.心脏增大l3.充血性心力衰竭l4.心包积液CarditisMyocarditis（心肌炎）心肌炎）Endocarditis（心内膜炎）心内膜炎）Pericarditis（心包炎）心包炎）Large joints Multiple、migratory（游走性）游走性）Arthritis Chorea（舞蹈病）舞蹈病）Involuntary movements Development of ataxia Slurring of speechSubcutaneous Nodules（皮下结节）皮下结节）It usually occurs over the joints,scalp and spinal column Erythema Marginatum （环形红斑）环形红斑）Rash appears primarily on the trunk and the extremitisl1.血常规：Hb WBC Nl2.血沉l3.CRPl4.ASOl5.EKG:P RDiagnosis If it is rheumatic fever If it associated with carditis Judgement for rheumatic activity主要表现主要表现 次要表现次要表现有前驱的链球菌感染有前驱的链球菌感染证据证据心脏炎心脏炎关节痛关节痛咽喉拭子培养或快速咽喉拭子培养或快速链球菌抗原试验阳性链球菌抗原试验阳性 链球菌抗体效价升高链球菌抗体效价升高关节炎关节炎发热发热舞蹈病舞蹈病风湿热既往史环形红斑环形红斑 P-RP-R间期延长间期延长皮下结节皮下结节 急性感染反应物急性感染反应物表表1 Jones标准初发风湿热的诊断指标标准初发风湿热的诊断指标（1992年）年）1.舞蹈病舞蹈病 2.隐匿发病或缓慢发展的心脏炎隐匿发病或缓慢发展的心脏炎 3.有风湿病史或现患风湿性心脏病有风湿病史或现患风湿性心脏病Treatment Anti-infective therapy Anti-inflammatory agents aspirin(阿司匹林阿司匹林)corticosteroids（皮质类固醇激素）皮质类固醇激素）Active treatment for currently symptomatic problemsProphylaxis Primary prevention（原发性预防）原发性预防）Secondary prevention（继发性预防）继发性预防）