The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Review of the Electrocardiography Changes and Clinical Manifestations of Scrub Typhus in a Single Center

쯔쯔가무시 환자에서의 심전도 변화 및 임상 양상에 대한 고찰

  • Kim, Jeong Min (Department of Internal Medicine, Keimyung University School of Medicine,) ;
  • Hyun, Miri (Department of Internal Medicine, Keimyung University School of Medicine,) ;
  • Kim, Hyun Ah (Department of Internal Medicine, Keimyung University School of Medicine,) ;
  • Kim, Mi Kyung (Department of Internal Medicine, Keimyung University School of Medicine,) ;
  • Kim, Jin Young (Department of Internal Medicine, Keimyung University School of Medicine,) ;
  • Kwon, Ki Young (Department of Internal Medicine, Keimyung University School of Medicine,) ;
  • Ryu, Seong-Yeol (Department of Internal Medicine, Keimyung University School of Medicine,)
  • 김정민 (계명대학교 의과대학 내과학교실) ;
  • 현미리 (계명대학교 의과대학 내과학교실) ;
  • 김현아 (계명대학교 의과대학 내과학교실) ;
  • 김미경 (계명대학교 의과대학 내과학교실) ;
  • 김진영 (계명대학교 의과대학 내과학교실) ;
  • 권기영 (계명대학교 의과대학 내과학교실) ;
  • 류성열 (계명대학교 의과대학 내과학교실)
  • Received : 2013.05.22
  • Accepted : 2013.10.18
  • Published : 2014.03.01
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Abstract

Background/Aims: Most scrub typhus patients have normal electrocardiography (ECG) findings. Recently, however, several cases with ECG changes were reported. However, few studies have examined the ECG changes in scrub typhus. Methods: The ECG and demographic data of patients infected with Orientia tsutsugamushi seen at Dongsan Medical Center from January 2008 to June 2012 were reviewed retrospectively. Patients with pre-existing cardiac disease were excluded. The initial and follow-up ECG findings, demographic characteristics, and laboratory findings was examined. Results: The group in which the initial ECG showed an arrhythmia had a higher blood urea nitrogen (BUN) level than the normal and ischemic groups (median 26.0 vs. 15.0 vs. 15.5 mg/dL, p = 0.041). The group with a sustained abnormality in the follow-up ECG had higher BUN (median 17.0 vs. 15.0 mg/dL, p = 0.022) and creatinine (median 1.30 vs. 0.90 mg/dL, p = 0.026) levels than the normal ECG group. In addition, the group with a sustained abnormality in the follow-up ECG had a higher rate of intensive care unit (ICU) admission (30.8% vs. 5.3%, p = 0.015) and longer treatment period (average 9 vs. 6 days, p = 0.027) than the other groups. Conclusions: In our study, more than 30% of the patients with scrub typhus showed ECG abnormalities. Those with an arrhythmic ECG change on presentation had high BUN levels. The sustained ECG abnormality group had high BUN and creatinine levels, and an increased ICU admission rate and length of stay. We should pay attention to the ECG findings on presentation and during the treatment of scrub typhus.

목적: 대부분의 쯔쯔가무시병 환자는 정상 심전도를 보이나 일부에서 비특이적 심전도 변화 및 심각한 심전도 변화에 대한 증례가 보고된 바 있다. 하지만 이에 대한 연구는 아직 부족한 실정으로 본 연구에서는 쯔쯔가무시병 환자의 심전도 변화에 대하여 알아보고자 하였다. 방법: 2008년부터 2012년까지 대학병원에 쯔쯔가무시병으로 입원한 환자를 대상으로 후향적 연구를 시행하였다. 기저 심질환자를 제외한 106명의 쯔쯔가무시 환자를 대상으로 내원 당시 심전도, 추적 심전도 소견, 인구학적 특성 및 검사실 소견을 조사하였다. 결과: 전체 환자 중 30% 이상의 환자가 내원 당시 비정상 심전도 소견을 보였다. 내원 당시 심전도가 부정맥을 보였던 군에서 혈액 요소 질소 수치 및 엔티 프로-비엔피 수치가 높았음을 알 수 있었다. 그리고 추적 심전도 검사에서 비정상 소견을 보이는 군의 혈액 요소 질소 및 크레아티닌 수치가 높았다. 또한 비정상 심전도가 변화 없이 지속된 군은 중환자실 입실 비율이 높고 입원 기간이 더 길다는 사실을 확인하였다. 결론: 쯔쯔가무시병 환자에서 심전도 변화가 중증도와 연관되어 있을 수 있으나 단일 기관 연구로 향후 추가적인 대규모 연구가 필요할 것으로 생각된다.

Keywords

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