《儿科学》风湿热（英文）-教学课件（非AI生成）.ppt

Rheumaticfever*?※Understandtheetiologyandpathologicfeaturesofrheumaticfever.?※Mastertheclinicalmanifestationsanddiagnosticcriteriaofrheumaticfever.?※Masterthetreatmentandpreventivemethodsofrheumaticfever.?PurposeandRequirement*OutlineRheumaticfeveriscloselyrelatedtoinfectionwithgroupAβ-hemolyticstreptococci.Rheumaticfeverismostfrequentlyobservedinchildrenfrom5~15yearofage.*Twoimmunereaction☆anaphylaxis(变态反应)☆auto-immunereaction（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＊Thestrainofinfectingorganism（感染的菌株）＊Hereditysusceptibilityofhost（宿主的遗传易感性）＊Socioeconomicstatus、weather（社会经济状况、气候）*PathologyProcessofpathologyweredivideintothreestages:Exudation（渗出期）、proliferation（增殖期）、sclerosis（硬化期）.butpathologicalchangesofeachstagecanexistatthesametime.Basicpathologicalchangesareinflammationandcharacteristic“aschoffbodies”（风湿小体）.*ClinicalManifestations△Fever△Carditis（心脏炎）△Polyarthritis（多发性关节炎）△Erythemamarginatum（环形红斑）△Subcutaneousnodules（皮下结节）△Chorea（舞蹈病）*Carditis＊Myocarditis（心肌炎）＊Endocarditis（心内膜炎）＊Pancarditis（心包炎）*﹡Largejoints﹡Multiple、migratory（游走性）Arthritis*Chorea（舞蹈病）InvoluntarymovementsDevelopmentofataxiaSlurringofspeech*SubcutaneousNodules（皮下结节）Itusuallyoccursoverthejoints,scalpandspinalcolumn*ErythemaMarginatum（环形红斑）Rashappearsprimarilyonthetrunkandtheextremitis*LaboratoryExamBloodRT:HbWBCNESRCRPASOEKG:P-R*Diagnosis☆Ifitisrheumaticfever☆Ifitassociatedwithcarditis☆Judgementforrheumaticactivity*主要表现次要表现有前驱的链球菌感染证据心脏炎关节痛咽喉拭子培养或快速链球菌抗原试验阳性链球菌抗体效价升高最近有猩红热史关节炎发热舞蹈病ESRCRP环形红斑P-R间期延长皮下结节风湿热既往史表1Jones标准初发风湿热的诊断指标（1992年）*下列三种情况可不必严格执行该诊断标准舞蹈病隐匿发病或缓慢发展的心脏炎有风湿病史或现患风湿性心脏病*Treatment