儿科学精品课件：风湿热.pptVIP

急性心脏炎存在依据 1.过去未有的器质性杂音 2.心脏增大 3.充血性心力衰竭 4.心包积液 实验室检查 1.血常规：Hb WBC N 2.血沉 3.CRP 4.ASO 5.EKG: P R * * 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 Requirement Outline Rheumatic fever is closely related to infection with group A β-hemolytic streptococci. Rheumatic fever is most frequently observed in children from 5~15 year of age. Two immune reaction ☆ anaphylaxis (变态反应) ☆auto- immune reaction（自身免疫反应） Pathogenesis 问题？ A组乙型溶血性链球菌感染可诱发风湿热已被公认，但在众多的A组乙型溶血性链球菌感染中为什么只有少数人（0.3%~3%）发生本病？ Etiology ＊The strain of infecting organism（感染的菌株） ＊Heredity susceptibility of host （宿主的遗传易感性） ＊ Socioeconomic status 、weather（社会经济状况、气候） Pathology Process of pathology were divide into three stages : Exudation （渗出期）、 proliferation（增殖期）、 sclerosis（硬化期）. but pathological changes of each stage can exist at the sametime . Basic pathological changes are inflammation and characteristic “aschoff bodies ” （风湿小体）. Clinical Manifestations △ Fever △ Carditis （心脏炎） △ Polyarthritis（多发性关节炎） △ Erythema marginatum（环形红斑） △ Subcutaneous nodules（皮下结节） △ Chorea（舞蹈病） Carditis ＊Myocarditis（心肌炎） ＊ Endocarditis（心内膜炎） ＊ Pericarditis（心包炎） ﹡Large joints ﹡Multiple 、migratory（游走性） Arthritis Chorea （舞蹈病） Involuntary movements Development of ataxia Slurring of speech Subcutaneous Nodules（皮下结节） It usually occurs over the joints, scalp and spinal column Erythema Marginatum （环形红斑） Rash appears primarily on the trunk and the extremitis Diagnosis ☆ If it is rheumatic fever ☆ If it associated with carditis ☆ Judgement for rheumatic activity *