成人恙虫病心电图改变及其临床价值研究

目的 探讨成人恙虫病患者心电图异常情况及其临床价值。方法 回顾性分析233例成人恙虫病病例（恙虫病组）,选取同期220例健康体检者为对照组,对比两组心电图异常情况;收集心电图异常患者临床资料,分析心电图异常与器官损害的关系。结果 恙虫病组心电图异常的患者比例（56.7%,132/233）高于对照组（40.0%,88/220）（P<0.001）。恙虫病组异常心电图发生频率高于对照组的有窦性心动过速（15.5%,36/233）、胸和（或）肢体导联低电压（10.7%,25/233）、房性早搏（6.0%,14/233）、U波改变（2.6%,6/233）（P_均<0.05）。恙虫病组心律失常发生频率（38.2%,89/233）高于对照组（P<0.001）,但两组严重心律失常发生频率均很低且无统计学差异（P=0.659）。低电压患者发生胸膜炎或心脏增大者比例（68.0%,17/25）高于非低电压患者（41.8%,87/208）（P<0.05）,并发器官功能障碍综合征（MODS）比例（20.0%,5/25）亦高于非低电压患者（5.3%,11/208）（P<0.05）。结论 成人恙虫病心电图异常非常普遍,心律失常常见但严重心律失常罕见;低电压患者需注意胸膜或心脏病变,甚至MODS可能,需密切监护和积极治疗。

Electrocardiographic changes and its clinical value in adult patients with scrub typhus

Objective To investigate the electrocardiographic (ECG) changes and its clinical value in adult patients with scrub typhus. Methods A retrospective analysis of 233 cases of adult scrub typhus was conducted as scrub typhus group, and 220 healthy subjects were selected as control group. The abnormalities of ECG were compared between the two groups. The clinical data of patients with abnormal ECG were collected to analyze the correlation between ECG abnormalities and organ damage. Results The proportion of patients with abnormal ECG in the scrub typhus group (56.7%, 132/233) was higher than that in the control group (40.0%, 88/220) (P<0.001). The frequency of sinus tachycardia (15.5%, 36/233), low voltage of chest and/or limb leads(10.7%, 25/233), atrial premature beats (6.0%, 14/233), U wave changes (2.6%, 6/233) in scrub typhus group were higher than that in the control group (all P<0.05). The frequency of arrhythmia in the scrub typhus group (38.2%, 89/233) was higher than that in the control group (P<0.001), but the incidence of severe arrhythmia in the two groups was very low and the difference was not statistically significant (P=0.659). The proportion of patients with pleural or heart enlargement in low-voltage patients (68.0%, 17/25) was higher than that in non-low-voltage patients (41.8%, 87/208) (P<0.05), and the proportion of organ dysfunction syndrome (MODS) (20.0%, 5/25) was also higher than non-low voltage patients (5.3%, 11/208) (P<0.05). Conclusions ECG abnormalities in adult patients with scrub typhus are very common; arrhythmias are common but severe arrhythmias are rare; patients with low-voltage leads need to be alert to pleural or heart disease or even MODS, requiring close monitoring and active treatment.