Evolutive Study of Rheumatic Carditis Cases Treated with Corticosteroids in a Public Hospital

Abstract Background: Rheumatic carditis is a challenge for treatment and secondary prophylaxis, due to severe valve sequelae. Objective: To evaluate the cases of rheumatic carditis in patients under 18 years old treated with corticosteroids. Methods: An observational, longitudinal and retrospective study was carried out on the profile of patients, in the period of 2000-2015. We selected those who received corticosteroid therapy at immunosuppressive doses, for the treatment of carditis and were aged 5 to 18 years. Data were extracted from medical records. Calculations of: averages, standard deviations, medians and interquartile ranges, ratios and 95% confidence intervals were obtained. Chi-square and Wilcoxon tests were applied for comparisons. The level of significance was 5%. Results: Of the 93 cases, 93.53% developed moderate or severe carditis. Mitral regurgitation was detected in 100% of the sample. Pulse therapy was administered in 11.83%. Surgery was performed in 23.69% of patients: mitral, aortic and/or tricuspid valve repair or replacement. The evolution of the cases was favorable in 70.96%. There was a good response among those who received only clinical treatment and those who belonged to the surgical group. The comparison of the initial and posterior valve lesions to the corticoid use was statistically significant (p < 0.001). A difference between the ejection fraction medians was observed (p = 0.048). Hospitalization was required twice or more for 45.16% of the patients. The mortality rate was 5.38%. Conclusions: The patients showed significant clinical improvement. The treatment was effective, reducing trivalvular impairment.

摘要
背景：风湿性心脏炎（rheumatic carditis）可引发严重的瓣膜后遗症，其治疗与二级预防始终是临床诊疗难题。
目的：评估接受糖皮质激素（corticosteroids）治疗的18岁以下风湿性心脏炎患者的病例情况。
方法：本研究为观察性纵向回顾性研究，针对2000年至2015年期间的患者概况展开分析，数据提取自该时段的门诊及住院病历，最终筛选出年龄为5~18岁、因心脏炎接受免疫抑制剂量糖皮质激素治疗的受试者。统计计算均数、标准差、中位数、四分位数间距、比值及95%置信区间（confidence intervals），采用卡方（chi-square）检验与威尔科克森（Wilcoxon）检验进行组间比较，检验水准设定为5%。
结果：本研究共纳入93例病例，其中93.53%的患者发展为中度或重度心脏炎；所有受试者均检出二尖瓣反流；11.83%的患者接受了糖皮质激素冲击治疗；23.69%的患者接受了手术治疗，手术方式包括二尖瓣、主动脉瓣及/或三尖瓣的修复或置换术。70.96%的病例预后良好，仅接受临床治疗者与手术组患者均获得了良好的治疗响应。对比糖皮质激素使用前后的瓣膜病变情况，差异具有统计学意义（p < 0.001）；两组射血分数（ejection fraction）中位数存在显著差异（p = 0.048）。45.16%的患者需接受2次及以上住院治疗，总体病死率为5.38%。
结论：本研究纳入的患者均获得了显著的临床改善，治疗方案有效，可减轻多瓣膜损害。