Chagas cardiomyopathy in the context of the chronic disease transition.
Chagas cardiomyopathy in the context of the chronic disease transition.
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DOI：
10.1371/journal.pntd.0000688
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发表时间：
2010-05-18
影响因子：
3.8
通讯作者：
Chagas Disease Working Group in Peru and Bolivia
中科院分区：
文献类型：
--
作者：
Hidron AI;Gilman RH;Justiniano J;Blackstock AJ;Lafuente C;Selum W;Calderon M;Verastegui M;Ferrufino L;Valencia E;Tornheim JA;O'Neal S;Comer R;Galdos-Cardenas G;Bern C;Chagas Disease Working Group in Peru and Bolivia
恰加斯病患者已移居城市，那里肥胖、高血压和其他心脏病危险因素很常见。该研究包括由玻利维亚圣克鲁斯一家公立医院心脏病学部门评估的成年患者。数据包括克氏锥虫感染的危险因素、病史、体格检查、心电图、超声心动图以及初步数据收集后 9 个月的接触情况以确定死亡率。对克氏锥虫进行了血清学和 PCR 检测。在 394 名参与者中，251 名（64%）通过血清学确诊克氏锥虫感染。在血清反应呈阳性的参与者中，109 名（43%）的常规 PCR 结果呈阳性；其中，89 例 (82%) 的实时 PCR 检测结果也呈阳性。高血压 (64%) 和超重 (体重指数 [BMI] >25; 67%) 的患病率很高，但克氏锥虫感染状况没有差异。近 60% 的症状性充血性心力衰竭归因于恰加斯心肌病；血清阳性患者的死亡率也高于血清阴性患者（p = 0.05）。在多变量模型中，在流行省份居住较长时间、在农村地区居住以及住房条件较差与克氏锥虫感染相关。男性、年龄增长和住房条件恶劣是恰加斯心肌病严重程度的独立预测因素。与女性或超重参与者相比，男性和 BMI ≤ 25 的参与者 PCR 结果呈阳性的可能性显着更高。恰加斯心肌病仍然是该医院人群充血性心力衰竭的重要原因，应在肥胖、高血压和慢性心血管疾病风险增加的流行病学转变背景下进行评估。拉丁美洲正在经历从传染病高发和过早死亡的发展中国家特有的疾病模式向工业化国家的模式转变，其中肥胖、高血压和糖尿病等慢性病更为常见。许多患有恰加斯病的农村居民现在已经迁移到城市，养成了新的习惯，可能同时患有这两种疾病。我们对玻利维亚圣克鲁斯市一家公立医院心脏病专家就诊的 394 名成年人的心脏病进行了研究； 64% 的人感染了克氏锥虫，这种寄生虫会导致恰加斯病。克氏锥虫感染者和未感染者的高血压（64%）和超重（67%）率均较高，且感染状况没有差异。近 60% 的症状性充血性心力衰竭是由恰加斯病引起的；感染者的死亡率也高于未感染者。男性和老年患者患有更严重的恰加斯心脏病。恰加斯心脏病仍然是该医院人群充血性心力衰竭的重要原因，但通常发生在同时患有肥胖、高血压和/或其他心脏危险因素的患者中。
Patients with Chagas disease have migrated to cities, where obesity, hypertension and other cardiac risk factors are common. The study included adult patients evaluated by the cardiology service in a public hospital in Santa Cruz, Bolivia. Data included risk factors for T. cruzi infection, medical history, physical examination, electrocardiogram, echocardiogram, and contact 9 months after initial data collection to ascertain mortality. Serology and PCR for Trypanosoma cruzi were performed. Of 394 participants, 251 (64%) had confirmed T. cruzi infection by serology. Among seropositive participants, 109 (43%) had positive results by conventional PCR; of these, 89 (82%) also had positive results by real time PCR. There was a high prevalence of hypertension (64%) and overweight (body mass index [BMI] >25; 67%), with no difference by T. cruzi infection status. Nearly 60% of symptomatic congestive heart failure was attributed to Chagas cardiomyopathy; mortality was also higher for seropositive than seronegative patients (p = 0.05). In multivariable models, longer residence in an endemic province, residence in a rural area and poor housing conditions were associated with T. cruzi infection. Male sex, increasing age and poor housing were independent predictors of Chagas cardiomyopathy severity. Males and participants with BMI ≤25 had significantly higher likelihood of positive PCR results compared to females or overweight participants. Chagas cardiomyopathy remains an important cause of congestive heart failure in this hospital population, and should be evaluated in the context of the epidemiological transition that has increased risk of obesity, hypertension and chronic cardiovascular disease. Latin America is undergoing a transition from disease patterns characteristic of developing countries with high rates of infectious disease and premature deaths to a pattern more like industrialized countries, in which chronic conditions such as obesity, hypertension and diabetes are more common. Many rural residents with Chagas disease have now migrated to cities, taken on new habits and may suffer from both types of disease. We studied heart disease among 394 adults seen by cardiologists in a public hospital in the city of Santa Cruz, Bolivia; 64% were infected with T. cruzi, the parasite that causes Chagas disease. Both T. cruzi infected and uninfected patients had a high rate of hypertension (64%) and overweight (67%), with no difference by infection status. Nearly 60% of symptomatic congestive heart failure was due to Chagas disease; mortality was also higher for infected than uninfected patients. Males and older patients had more severe Chagas heart disease. Chagas heart disease remains an important cause of congestive heart failure in this hospital population, but often occurs in patients who also have obesity, hypertension and/or other cardiac risk factors.
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DOI：
10.4269/ajtmh.2008.79.768
发表时间：
2008-11-01
影响因子：
3.3
作者：
Fitzwater, Sean;Calderon, Maritza;Bern, Caryn
通讯作者：
Bern, Caryn
影响因子：
37.8
作者：
MAGUIRE, JH;HOFF, R;WELLER, TH
通讯作者：
WELLER, TH
影响因子：
2
作者：
Castro, AM;Luquetti, AO;Galvao, LMC
通讯作者：
Galvao, LMC
DOI：
10.1590/s0074-02762007005000092
发表时间：
2007-10-01
期刊：
Memórias do Instituto Oswaldo Cruz
影响因子：
--
作者：
Dias, João Carlos Pinto
通讯作者：
Dias, João Carlos Pinto
影响因子：
2
作者：
Bustamante, Juan M.;Novarese, Monica;Paglini-Oliva, Patricia A.
通讯作者：
Paglini-Oliva, Patricia A.