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急性风湿热的流行病学和发病机理

Author
Allan Gibofsky, MD, JD, FACP, FCLM
Section Editors
Robert Sundel, MD
Daniel J Sexton, MD
Sheldon L Kaplan, MD
Deputy Editor
Elizabeth TePas, MD, MS
Translators
古洁若, 主任医师，教授

引言

急性风湿热(acute rheumatic fever, ARF)是一种由A组链球菌(group A streptococcus, GAS)引起的咽部感染的迟发性、非化脓性后遗症。从出现初始咽炎到ARF首发症状或体征期间，有2-3周的潜伏期[1]。该病具有多种临床表现，可能包括关节炎、心脏炎、舞蹈病、皮下结节以及边缘性红斑。

ARF的流行病学及发病机制总结在此。其临床表现、诊断、治疗和预防将单独讨论。 (参见“Acute rheumatic fever: Clinical manifestations and diagnosis”和“急性风湿热的治疗与预防”)

流行病学

据估计，在世界范围内的发展中地区，ARF及风湿性心脏病累及了近2000万人，且是50岁之前因心血管疾病死亡的主要原因[2]。任何年龄段都可能发生风湿热，但大多数病例见于5-15岁的儿童[3-5]。在世界范围内，每年有470,000例新发风湿热病例和233,000例因风湿热或风湿性心脏病死亡的病例；大多数发生于发展中国家和原住民群体中[2,6]。ARF的平均发病率为19/100,000[7]。

在美国及其他发达国家，ARF的发病率要低得多，为2-14例/100,000人，可能与卫生标准提高和常规使用抗生素治疗急性咽炎有关[8,9]。实发病例中有很多都是在区域性疾病暴发中产生的[10-15]。 (参见“成人急性咽炎的评估”和“儿童及青少年急性感染性咽炎的诊断方法”)

在20世纪10年代中期疾病流行期间，多达3%的未治疗急性链球菌咽痛随后发展为风湿热；在地方性感染中，风湿热的发病率大幅下降[16]。

          

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-03.
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