钩端螺旋体病患者急性冠状动脉综合征风险增加：一项全国性队列分析。

Increased risk of acute coronary syndrome among leptospirosis patients: A nationwide cohort analysis.

作者信息

Chung Wei-Sheng, Chu Yung-Hua, Lin Cheng-Li, Kao Chia-Hung

机构信息

Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.

Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.

出版信息

Int J Cardiol. 2015 Apr 1;184:576-580. doi: 10.1016/j.ijcard.2015.03.021. Epub 2015 Mar 4.

DOI:10.1016/j.ijcard.2015.03.021

PMID:25769002

Abstract

BACKGROUND

Studies on the association between leptospirosis and acute coronary syndrome (ACS) are lacking. Therefore, this study identifies the effects of leptospirosis on the risks of developing ACS with a nationwide retrospective cohort study.

METHODS

We identified adult patients aged ≥20 years who were newly diagnosed with leptospirosis. We also randomly selected a comparison cohort from the general population by using a propensity score matching method. We analyzed the risks of ACS by using Cox proportional hazard regression models.

RESULTS

Among the 23.74 million people in the cohort, 3690 patients with leptospirosis (68% men, mean age of 52.2 years) and 3690 controls were followed for 13,677 and 15,652 person-years, respectively. The overall incidence of ACS was higher in the leptospirosis cohort than in the nonleptospirosis cohort (4.68 vs 3.71 per 1000 person-years), with a hazard ratio (HR) of 1.69 (95% confidence interval [CI]=1.12-2.56). Men exhibited a 1.88-fold greater HR of ACS than women did (95% CI=1.20-2.94). The risk of developing ACS was highest for leptospirosis patients aged ≥65 years (HR=7, 51% CI=4.35-12.9) compared with patients aged ≤49 years.

CONCLUSION

Leptospirosis is not a previously identified risk factor for ACS. The findings of this nationwide retrospective cohort study indicate that leptospirosis may become an independent risk factor for ACS. Future research to investigate the mechanism is warranted.

摘要

背景

关于钩端螺旋体病与急性冠状动脉综合征（ACS）之间关联的研究尚缺。因此，本研究通过一项全国性回顾性队列研究，确定钩端螺旋体病对发生ACS风险的影响。

方法

我们纳入了年龄≥20岁、新诊断为钩端螺旋体病的成年患者。我们还采用倾向评分匹配法从普通人群中随机选取了一个对照队列。我们使用Cox比例风险回归模型分析ACS风险。

结果

在该队列的2374万人中，3690例钩端螺旋体病患者（68%为男性，平均年龄52.2岁）和3690名对照分别随访了13677和15652人年。钩端螺旋体病队列中ACS的总体发病率高于非钩端螺旋体病队列（每1000人年分别为4.68例和3.71例），风险比（HR）为1.69（95%置信区间[CI]=1.12 - 2.56）。男性发生ACS的HR比女性高1.88倍（95% CI=1.20 - 2.94）。与年龄≤49岁的患者相比，年龄≥65岁的钩端螺旋体病患者发生ACS的风险最高（HR=7，51% CI=4.35 - 12.9）。