恙虫病并发心脏损伤的临床分析

Clinical analysis of cardiac injury in tsutsugamushi disease

目的探讨恙虫病并发心脏损伤的临床表现及影响预后的因素。方法回顾性分析1985年6月至2012年8月本院收治的200例恙虫病患者的临床资料，包括主要临床表现、血清外斐试验、心肌酶谱和心电图检查结果等。所有患者按确诊时间长短分为确诊时间〈7d组、确诊时间7～13d组和确诊时间≥14d组3组，按年龄分为〈60岁组和t〉60岁组2组，分析患者确诊时间和年龄对患者心脏损伤及预后的影响。结果200例恙虫病患者大多数出现符合恙虫病的典型临床表现，其中33例（16．5％）出现心悸、胸闷，20例（10．0％）发生急性左心功能衰竭；153例（76．5％）出现1项或多项心肌酶活性升高，以乳酸脱氢酶（LDH）升高最常见；111例（55．5％）出现心电图异常，少数患者发生高危性心律失常。与确诊时间≥14d组比较，确诊时间〈7d组患者的死亡比例显著降低（1．5％比15．4％，P〈0．05）。与年龄〈60岁组比较，年龄／〉60岁组患者心电图异常及死亡比例显著升高（64．7％比48．7％，12．9％比2．6％，均P〈0．05）。结论恙虫病患者并发心脏损伤的比例较高，其预后与确诊时间和患者年龄有关联。

Objective To explore the clinical manifestations and prognostic factors of cardiac injury in patients with tsutsugamushi disease. Methods The clinical data of 200 patients with tsutsugamushi disease who were admitted to our hospital between June 1985 and August 2012 were retrospectively analyzed, including the clinical manifestations, Well-Felix test, myocardial enzyme profiles and electrocardiogram, etc. Patients were allocated based on the time from onset to confirmation of diagnosis （groups 〈7 d, 7-13 d and ≥14 d） and the age （groups 〈60 years and≥60 years ） for determination of their effects on cardiac injury and the prognosis. Results Of 200 cases with tsutsugamushi disease mostly presented with typical clinical manifestations, 33 （16.5%） complained of palpitation and chest distress, 20 （10.0%） were accompanied by acute left heart failure, 153 （76.5%） had an elevation of one or more cardiac enzymes as predominated by increasing of lactate dehydrogenase, and 111 （55.5%） showed aberrant electrocardiogram with a minority developed into high-risk arrhythmia. Patients in the 〈7 d group had a significant lower mortality than those in the ≥14 d group （1.5% vs 15.4%, P〈0.05）. The≥60 year group was characterized by a significantly higher probability of aberrant electrocardiogram and mortality than the 〈60 year group （64.7% vs 48.7% and 12.9% vs 2.6%, both P〈0.05）. Conclusion Patients with tsutsugamushi disease have a high incidence of cardiac injury, and the prognosis is related with the age and the time from onset to confirmation of diagnosis.