女，12岁，发热2周，1周来右膝关节、左踝关节相继红肿痛并有活动障碍，心尖部有2/6级收缩期杂音，末梢血白细胞15xlO9/L，N0.80,Hb120g/L,PLT156x109/L。确诊本病儿诊断的主要标准是

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