9.2010八年制自身免疫.ppt

教学目的与要求 了解 : 病理分期（渗出、增生、硬化期） 熟悉 : 病因 ; 发病机理 ; 鉴别诊断 掌握 : 临床表现 ; Jones诊断标准； 治疗预防原则 ; 风湿热活动指标 Rheumatic fever is an immunological inflammatory disease follows infection with certain strains of group A streptococci easily recur without prophylaxis incidence：22/100000 in China season：winter or spring age：5 – 15y Pathogenesis molecular mimicry of bacterial antigens similarity between bacterial and self molecules as recognized by immune cells leading to across-react with target organs in the body circulating immune complexes (CIC) circulating immune complexes activate the complement system leading to the inflammatory changes Genetic proneness HLA-B35、HLA-DR4 Clinical Manifestation Major clinical manifestations: carditis; polyarthritis; chorea; subcutancous nodules; erythema marginatum Ordinary complaints: fever / arthralgia Duration of acute rheumatic fever: ≤6 months rheumatic carditis Incidence: 40~50% One and only permanent damage Endocarditis Myocarditis Pericarditis Congestive heart failure during the initial episode: 5%~10% Myocarditis Tachycardia disproportionate to the fever Congestive heart failure Gallop rhythm Soft systolic murmur heard at the apex ECG abnormalitis： arrhythmias; prolongation of the P-R interval; atrioventricular block (AVB) Cardiomegaly on x-ray Endocarditis Mitral regurgitation: Apical systolic murmur at the apex Relative mitral stenosis: Low-pitched mid-diastolic rumble Aortic regurgitation: Diastolic murmur in the third costa at the left side of the sternum Pericarditis Precordial pain Pericardial effusion A friction rub pericardial tamponade hypotension; muffled heart sounds; jugular venous distension Striking increase in heart size on X-ray Echocardiography: pericardial effusion ＞50ml Rheumatic arthritis Incidence: 50%~60% Acute migratory pol