目的:为了估计进展,在年龄<25岁诊断的儿童和青年中,临界和轻度潜伏性RHD的回归和持续率。
方法:根据系统评价和荟萃分析指南的首选报告项目进行综述。在电子数据库中搜索潜在的RHD超声心动图随访研究,这些研究使用了世界心脏联合会的诊断标准。对临界和轻度疾病亚类的结局进行了荟萃分析。
结果:纳入了来自12项研究的1618名个体的数据。对于临界情况,48.51%回归(95CI45.10-51.93),进步了13.99%(95CI9.72-18.25),38.61%的患者在随访时患有持续性(不变)疾病(95CI29.68-47.54)。对于轻度明确的病例,34.01%回归(95CI28.88-39.15),进展8.06%(95CI3.65-16.90),60.23%患有持续性疾病(95CI55.08-67.38)。
结论:边缘和轻度确定的潜伏性RHD在初始诊断后显示出可变的演变。虽然8%的轻度明确病例和14%的临界病例在随访时有疾病进展的迹象,轻度明确病例的三分之一和临界病例的一半有疾病消退,即使有足够的抗生素预防。研究队列之间的显着差异表明,潜在的RHD自然史可能在全球不同的流行地区之间存在差异。需要未来的研究来确定那些将最受益于抗生素预防的个体,并确定潜在RHD的区域自然史。
OBJECTIVE: To estimate progression, regression and persistence rates for borderline and mild-definite
latent RHD in children and youth diagnosed at age < 25 years.
METHODS: A review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Electronic databases were searched for
latent RHD echocardiography follow-up studies which used World Heart Federation diagnostic criteria. A meta-analysis of outcomes was conducted for borderline and mild-definite disease subcategories.
RESULTS: Data for 1618 individuals from 12 studies were included. For borderline cases, 48.51% regressed (95%CI 45.10-51.93), 13.99% progressed (95%CI 9.72-18.25), and 38.61% had persistent (unchanged) disease at follow-up (95%CI 29.68-47.54). For mild-definite cases, 34.01% regressed (95%CI 28.88-39.15), 8.06% progressed (95%CI 3.65-16.90), and 60.23% had persistent disease (95%CI 55.08-67.38).
CONCLUSIONS: Borderline and mild-definite
latent RHD show variable evolution following initial diagnosis. While 8% of mild-definite and 14% borderline cases had signs of disease progression at follow-up, a third of mild-definite and half of borderline cases had disease regression, even with sub adequate antibiotic prophylaxis. The significant variability between study cohorts suggests
latent RHD natural history is likely variable between different endemic regions globally. Future research is needed to identify those individuals who would most benefit from antibiotic prophylaxis and determine regional natural history of
latent RHD.