日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 36(4): 277-284 (2020)
doi:10.9794/jspccs.36.277

原著Original

心炎を伴ったリウマチ熱6例の臨床経過と予後Clinical Course and Prognosis of Acute Rheumatic Fever with Carditis in Six Patients

1筑波大学附属病院小児科Department of Pediatrics, University of Tsukuba Hospital ◇ Ibaraki, Japan

2筑波大学医学医療系小児科Department of Child Health, Faculty of Medicine, University of Tsukuba ◇ Ibaraki, Japan

3茨城県立こども病院小児循環器科Department of Pediatric Cardiology, Ibaraki Children’s Hospital ◇ Ibaraki, Japan

受付日:2020年5月14日Received: May 14, 2020
受理日:2020年7月20日Accepted: July 20, 2020
発行日:2020年12月1日Published: December 1, 2020
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背景:近年,本邦で急性リウマチ熱(ARF)を経験する機会はまれで,新規発症例の報告は毎年5~10例であるが,診断・治療が遅れると心不全を来すこともある重篤な疾患である.

方法:1994~2018年に我々の施設で診断された心炎を伴うARF 6例の臨床経過と予後について,診療録から後方視的に検討した.

結果:診断時年齢は3~13歳(中央値8.5歳),女児3例であった.初発症状は4例が発熱と関節症状,1例が関節症状,1例が心不全に伴う息切れと易疲労感であった.初診からARFの診断に至るまでの期間は3日~4年10か月(中央値11.5日)で,関節炎として他の診療科で治療された例は診断が遅れる傾向があった.Jones診断基準の大項目で認められたのは心炎,多発関節炎のみであった.弁膜炎としては大動脈弁閉鎖不全(AR)が5例に,僧帽弁閉鎖不全(MR)が3例に認められ,2例は両者を合併した.いずれもプレドニゾロン,アスピリン,抗菌薬で治療され(予防投与含む),1~15年(中央値9年)の経過観察期間でMRは改善したが,ARは残存し,2例は弁置換術が必要となった.ARFの再発は認められなかった.

結論:今回の検討では,初期に関節症状が目立ち,心炎の診断が遅れて重症化する例があった.溶連菌感染に関連した多発関節炎の診療においては,小児循環器科医による心炎のスクリーニングが重要であると考えられた.

Background: In recent years, acute rheumatic fever (ARF) has been considered an extremely rare condition in Japan, with an incidence of 5–10 cases annually. However, it should be recognized as a serious illness because some patients may develop heart failure (HF) if diagnosis and treatment are delayed.

Methods: The clinical course and prognoses of ARF with carditis in six patients (n=3 women) diagnosed in our institutions from 1994 to 2018 were investigated by retrospectively reviewing medical records.

Results: The age at diagnosis was 3–13 (median: 8.5) years. The symptoms at onset were fever and arthralgia/arthritis in four, arthralgia/arthritis alone in one, and shortness of breath and fatigability due to HF in one patient. The duration from the initial presentation to the diagnosis of ARF ranged from 3 days to 4 years and 10 months (median: 11.5 days). None of the patients presented with major symptoms other than carditis and polyarthritis based on the revised Jones Criteria. Similar to valvulitis, aortic valve regurgitation (AR), mitral regurgitation (MR), and both AR and MR were observed in 5, 3, and 2 cases, respectively. The patients were treated with prednisolone and/or aspirin and antibiotics (provided as prophylaxis drugs). During follow-up (range: 1–15 [median: 9] years), MR almost disappeared; however, AR remained. Moreover, aortic valve replacement was required in two cases, and recurrence of ARF was not noted.

Conclusion: In this study, arthritis-related symptoms were more likely to be observed during the initial presentation, and the diagnosis of carditis was delayed, resulting in a critical clinical course in some cases. Patients with streptococcal infection-related polyarthritis should be screened for carditis by a pediatric cardiologist.

Key words: acute rheumatic fever; rheumatic heart disease; valvulitis; arthritis; aortic valve replacement

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This page was last modified on 2020-12-22T09:22:56.000+09:00


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