重症恙虫病脂质异常与并发症的关联

The Association of Lipid Abnormalities with Complications in Severe Scrub Typhus.

作者信息

Sarswat Ravi, Singh Balraj, Singh Akash, Mahajan Sanjay

机构信息

Resident, Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

Associate Professor, Department of Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

出版信息

J Assoc Physicians India. 2024 Dec;72(12):e17-e21. doi: 10.59556/japi.72.0746.

DOI:10.59556/japi.72.0746

PMID:39676191

Abstract

AIM

To study abnormalities of lipids in patients suffering from severe scrub typhus and their relationship with complications.

METHODS

This cohort study was conducted in patients of severe scrub typhus [immunoglobulin (IgM) positive by enzyme-linked immunosorbent assay (ELISA)] admitted to our institute from 1 August 2020 through 31 July 2021. The lipid profile was estimated initially at the time of hospitalization. Serum total cholesterol, serum triglyceride levels (TGs), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) were estimated. The association (risk ratios) of lipids abnormalities was determined with mortality, multiple organ dysfunction syndrome (MODS), septic shock, and septic shock with MODS.

RESULTS

We studied 100 patients (mean age of 48.4 ± 16.3 years) of whom 73 (73%) were females. On presentation, fever (91%), myalgias (38%), abdominal pain (16%), shortness of breath (15%), and cough (12%) were main symptoms. On examination, tachypnoea (68%), tachycardia (65%), conjunctival suffusion (37%), icterus (29%), eschar (14%), abdominal tenderness (10%), splenomegaly (4%), and hepatomegaly (3%) were noted. In lipid abnormalities, 93 (93%) patients had low HDL-C (males <40 mg/dL, females <50 mg/dL), serum triglycerides (200 mg/dL) were elevated in 71 (71%) patients, serum total cholesterol (>240 mg/dL) was increased in 4 (4%) patients, and 4 patients had raised serum LDL-C levels (160-189 mg/dL). Sixty-two (62%) patients developed MODS, 16 (16%) had septic shock, 15 (15%) developed septic shock with MODS, and 4 (4%) patients died. High serum TGs (>200 mg/dL) were associated with MODS (RR = 1.6, 95% CI = 1.2-2.0, = 0.008) and septic shock with MODS (RR = 4.2, 95% CI = 1-17.4, = 0.022) and the serum LDL-C levels <50 mg/dL were associated with MODS (RR = 1.6, 95% CI = 1.2-2.0, = 0.007).

CONCLUSION

There was a significant association of increased severity of scrub typhus with high TGs (>200 mg/dL) levels and low levels of LDL-C (<50 mg/dL) in admitted patients of severe scrub typhus.

摘要

目的

研究重症恙虫病患者的血脂异常情况及其与并发症的关系。

方法

本队列研究纳入了2020年8月1日至2021年7月31日期间我院收治的重症恙虫病患者（酶联免疫吸附测定法（ELISA）检测免疫球蛋白（IgM）呈阳性）。入院时初步评估血脂情况。检测血清总胆固醇、血清甘油三酯水平（TGs）、高密度脂蛋白（HDL-C）和低密度脂蛋白（LDL-C）。确定血脂异常与死亡率、多器官功能障碍综合征（MODS）、感染性休克以及合并MODS的感染性休克之间的关联（风险比）。

结果

我们研究了100例患者（平均年龄48.4±16.3岁），其中73例（73%）为女性。就诊时，主要症状为发热（91%）、肌痛（38%）、腹痛（16%）、呼吸急促（15%）和咳嗽（12%）。检查发现，呼吸急促（68%）、心动过速（65%）、结膜充血（37%）、黄疸（29%）、焦痂（14%）、腹部压痛（10%）、脾肿大（4%）和肝肿大（3%）。在血脂异常方面，93例（93%）患者HDL-C水平低（男性<40mg/dL，女性<50mg/dL），71例（71%）患者血清甘油三酯升高（>200mg/dL），4例（4%）患者血清总胆固醇升高（>240mg/dL），4例患者血清LDL-C水平升高（160 - 189mg/dL）。62例（62%）患者发生MODS，16例（16%）发生感染性休克，15例（15%）发生合并MODS的感染性休克，4例（4%）患者死亡。高血清TGs（>200mg/dL）与MODS（RR = 1.6，95%CI = 1.2 - 2.0，P = 0.008）以及合并MODS的感染性休克相关（RR = 4.2，95%CI = 1 - 17.4，P = 0.022），血清LDL-C水平<50mg/dL与MODS相关（RR = 1.6，95%CI = 1.2 - 2.0，P = 0.007）。