Berra H, Carnevali F, Revelli S, Moreno H, Maris Pezzotto S, Morini J C, Bottasso O
Sanatorio Regional Rosendo García, Rosario, Argentina.
Arch Med Res. 1998 Autumn;29(3):241-6.
We analyzed the potential influence that associated risk factors (ARF), such as smoking, alcoholism, overweight, and hypertension, could have on the establishment of chronic chagasic cardiomyopathy (CC). The sample was comprised of 124 individuals, 69 males and 55 females (mean age +/- SD, 41 +/- 9.5 years), who were born in en demic areas of Northern Argentina and migrated further to Rosario City, an area where autochthonous cases of Chagas' disease have never been registered. Assessments included the following: clinical examination to discard previous cardiomyopathies; search for the presence of ARF according to standard criteria; specific serology; frontal chest X-ray, and 12-lead resting electrocardiogram (ECG). Subjects were classified on the basis of their serological status and presence of ARF into four groups: Tc+ARF+ T. cruzi-infected persons with ARF (n = 41); Tc-ARF+ seronegativity in presence of ARF (n = 27); Tc+ARF- individuals showing positive serology that lacked ARF (n = 27), and Tc-ARF- seronegative individuals having no ARF (n = 29).
Except for a higher female/male ratio in groups presenting no ARF (p < 0.02), no statistical differences as to age, length of residence in endemicity areas (LR), and ARF distribution were recorded among groups. Forty-one persons presented abnormal ECG tracings, distributed thus: Tc+ARF+, 18/41; Tc-ARF+, 14/27, Tc+ARF-, 14/27, and Tc-ARF, 4/29 (p < 0.01, in relation to the latter group). Subjects from the Tc+ARF+, Tc-ARF+, and Tc+ARF- groups had 4.89-, 6.7-, and 6.7-fold increases, respectively, if having an abnormal ECG when compared with Tc-ARF- individuals. Comparisons on the frequency of abnormal ECG between seropositives carrying ARF or not yielded a non-significant odds ratio, be it estimated as crude, or after adjusting for sex, age, and LR in multivariate analysis.
Presence of ARF was not associated with an increasing risk of cardiac affectation in chronically T. cruzi-infected persons, but resulted in chagasic-compatible ECG abnormalities in those seronegative individuals.
我们分析了吸烟、酗酒、超重和高血压等相关危险因素（ARF）对慢性查加斯心肌病（CC）发病可能产生的潜在影响。样本包括124人，其中男性69人，女性55人（平均年龄±标准差，41±9.5岁），他们出生于阿根廷北部的流行地区，后迁移至罗萨里奥市，该地区从未登记过恰加斯病的本地病例。评估包括以下内容：临床检查以排除既往心肌病；根据标准标准查找ARF的存在情况；特异性血清学检查；胸部正位X线片和12导联静息心电图（ECG）。根据血清学状态和ARF的存在情况将受试者分为四组：Tc+ARF+，感染克氏锥虫且有ARF的人（n = 41）；Tc-ARF+，存在ARF但血清学阴性的人（n = 27）；Tc+ARF-，血清学阳性但无ARF的个体（n = 27），以及Tc-ARF-，无ARF的血清学阴性个体（n = 29）。
除了无ARF组的女性/男性比例较高（p < 0.02）外，各年龄组在年龄、在流行地区的居住时间（LR）和ARF分布方面未记录到统计学差异。41人出现异常心电图描记，分布如下：Tc+ARF+组，18/41；Tc-ARF+组，14/27；Tc+ARF-组，14/27；Tc-ARF-组，4/29（与后一组相比，p < 0.01）。与Tc-ARF-个体相比，Tc+ARF+、Tc-ARF+和Tc+ARF-组出现异常心电图的几率分别增加了4.89倍、6.7倍和6.7倍。在携带或不携带ARF的血清阳性者之间比较异常心电图的频率，无论是粗略估计还是在多变量分析中对性别、年龄和LR进行校正后，得到的优势比均无统计学意义。
ARF的存在与慢性克氏锥虫感染者心脏受累风险的增加无关，但在那些血清学阴性个体中导致了符合查加斯病的心电图异常。
