Ostergaard L, Huniche B, Andersen P L
Department of Infectious Diseases, Marselisborg Hospital, Aarhus, Denmark.
J Infect. 1996 Nov;33(3):185-91. doi: 10.1016/s0163-4453(96)92225-2.
Relative bradycardia in infectious diseases is a poorly defined term. No exact and useful definition exists and the underlying mechanisms are unknown. Despite this, the term is often used in the literature and in clinical practice both as a clinical sign for an individual patient and as a characteristic feature of certain specific diseases. In this study a definition of relative bradycardia as a clinical sign in an individual patient and a definition of relative bradycardia as a characteristic feature of a specific disease were established based on a reference population comprising 673 patients with various infectious diseases. Relative bradycardia as a clinical sign in an individual patient held no predictive value regarding the likely type of infection. Relative bradycardia as a characteristic feature of specific disease was found for typhoid fever (P = 0.003), Legionnaire's disease (P = 0.005), and pneumonia caused by Chlamydia sp. (P = 0.0005), but not for mycoplasma pneumonia. It was not found for other pulmonary infections, infections caused by other Salmonella sp., other extracellular Gram-negative infections, or viral infections. Thus, relative bradycardia as a clinical sign has no predictive value for obtaining a tentative diagnosis, but relative bradycardia as a feature of specific disease is seen in typhoid fever, Legionnaire's disease, and pneumonia caused by Chlamydia sp. It seems that relative bradycardia as a feature of specific disease only occurs in diseases caused by organisms that are both Gram-negative and intracellular.
传染病中的相对心动过缓是一个定义不明确的术语。不存在确切且有用的定义，其潜在机制也尚不清楚。尽管如此，该术语在文献和临床实践中经常被用作个体患者的临床体征以及某些特定疾病的特征。在本研究中，基于一个由673名患有各种传染病的患者组成的参考人群，确立了个体患者相对心动过缓作为临床体征的定义以及相对心动过缓作为特定疾病特征的定义。个体患者相对心动过缓作为临床体征对可能的感染类型没有预测价值。发现伤寒（P = 0.003）、军团病（P = 0.005）和衣原体引起的肺炎（P = 0.0005）存在相对心动过缓作为特定疾病的特征，但支原体肺炎不存在。在其他肺部感染、其他沙门氏菌引起的感染、其他细胞外革兰氏阴性菌感染或病毒感染中未发现。因此，相对心动过缓作为临床体征对获得初步诊断没有预测价值，但相对心动过缓作为特定疾病的特征在伤寒、军团病和衣原体引起的肺炎中可见。似乎相对心动过缓作为特定疾病的特征仅发生在由革兰氏阴性且为细胞内寄生的生物体引起的疾病中。
