Chung Wei-Sheng, Lin Cheng-Li, Hsu Wu-Huei, Kao Chia-Hung
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan.
Heart. 2014 Dec;100(23):1844-50. doi: 10.1136/heartjnl-2014-306181. Epub 2014 Aug 21.
Studies investigating the epidemiological relationship between scrub typhus and the subsequent development of acute coronary syndrome (ACS) are lacking. Therefore, we conducted a nationwide longitudinal cohort study in Taiwan to explore whether patients with scrub typhus are at an increased risk of developing ACS.
This study investigated the incidence and risk factors for ACS in 5215 patients newly diagnosed with scrub typhus from the Taiwan National Health Insurance Research Database between 2000 and 2011. The comparison cohort contained 20 860 persons from the general population without scrub typhus. The follow-up period ran from the time of the initial diagnosis for scrub typhus to the date of an ACS event, censoring, or 31 December 2011. We used Cox proportional hazard regression models to analyse the risk of ACS by including the variables of sex, age and comorbidities.
The incidence of ACS was higher in patients with scrub typhus than in the comparison cohort (3.10 vs 1.92 per 1000 person-years). The HR of developing ACS increased by 37% in patients with scrub typhus after adjusting for age, sex and comorbidities. Men, increased age, hypertension, diabetes, hyperlipidaemia, chronic obstructive pulmonary disease and coronary artery disease were identified as independent risk factors of developing ACS after controlling for covariates. The prominent effect of scrub typhus on subsequent ACS development appeared within 1 year after infection.
This nationwide study determined that patients with scrub typhus exhibited a 37% increase in the risk of subsequently developing ACS compared with that of the general population.
目前缺乏关于恙虫病与随后发生急性冠状动脉综合征（ACS）之间流行病学关系的研究。因此，我们在台湾进行了一项全国性的纵向队列研究，以探讨恙虫病患者发生ACS的风险是否增加。
本研究调查了2000年至2011年期间台湾全民健康保险研究数据库中5215例新诊断为恙虫病患者的ACS发病率及危险因素。对照组包含20860名无恙虫病的普通人群。随访期从恙虫病初始诊断时间至ACS事件发生日期、失访日期或2011年12月31日。我们使用Cox比例风险回归模型，纳入性别、年龄和合并症等变量来分析ACS风险。
恙虫病患者的ACS发病率高于对照组（每1000人年分别为3.10和1.92）。在调整年龄、性别和合并症后，恙虫病患者发生ACS的风险比增加了37%。在控制协变量后，男性、年龄增加、高血压、糖尿病、高脂血症、慢性阻塞性肺疾病和冠状动脉疾病被确定为发生ACS的独立危险因素。恙虫病对随后ACS发生的显著影响出现在感染后1年内。
这项全国性研究确定，与普通人群相比，恙虫病患者随后发生ACS的风险增加了37%。
