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原先认为几乎所有的风湿病急性发作都伴有明显或隐性心肌炎,迟早要导致心脏瓣膜病。现已证实,风湿性多关节炎并不一定伴发心肌炎,而且多关节炎愈严重则愈少伴发心肌炎。心脏瓣膜病发生率取决于第1次发作时心肌炎的严重程度。表现为心动过速、第一心音减弱、收缩期杂音、有心电图改变而无心脏增大的轻度心肌炎,即使治疗方法不同亦常无瓣膜损害。伴有心脏增大而无心力衰竭的中度心肌炎以及伴有心脏增大、充血性心力衰竭的重度心肌炎常造成心脏瓣膜损害。在患风湿性关节炎而无心肌炎的患者中,10年后发生心脏瓣膜病的仅6%;轻型心肌炎为30%;而重度心肌炎则高达60%。如仅根据多关节炎或舞蹈病必然导致心肌炎这一点对疗效进行临床评价,而在研究
It was originally thought that almost all of the acute episodes of rheumatism were accompanied by overt or recessive myocarditis, leading to heart valve disease sooner or later. It has been confirmed that rheumatoid arthritis is not necessarily accompanied by myocarditis, but the more the less severe polyarthritis associated with myocarditis. The incidence of heart valve disease depends on the severity of myocarditis at the first attack. The performance of tachycardia, the first heart sound weakened, systolic murmur, ECG changes without cardiac enlargement of mild myocarditis, even if the treatment is also often without valvular damage. Moderate myocarditis associated with heart enlargement without heart failure, and severe myocarditis associated with enlarged heart and congestive heart failure often result in heart valve damage. In patients with rheumatoid arthritis without myocarditis, only 6% of heart valve disease occurs after 10 years; 30% for light myocarditis; and 60% for severe myocarditis. If only according to polyarthritis or chorea necessarily lead to myocarditis this point clinical evaluation of efficacy, and in the study