初发HIV感染男性病人静息心率及QTc间期分析

Analysis of resting heart rate and QTc interval length in initial HIV infection of males

目的分析初发艾滋病病毒(HIV)感染男性病人的12导联心电图中静息心率及QTc间期特点。方法收集首都医科大学附属北京地坛医院初次确诊的HIV抗体阳性的男性病人,并选取男性健康志愿者为对照组,应用12导联心电图检查,比较组间静息心率、QRS间期及QTc间期的差异,并按CD4+T淋巴细胞(简称CD4细胞)计数水平分级,按HIV病毒载量水平分组,比较组间静息心率、QRS间期及QTc间期的差异。结果共纳入病例组病人及健康对照组各154例,其中QTc间期延长病例组17例(11.04%),对照组2例(1.30%),两组比较差异无统计学意义(P> 0.05);病例组静息心率(83.81±14.13)bpm较对照组的静息心率(72.08±7.42)bpm明显增加(P <0.05);病例组亚组中,静息心率随CD4细胞计数的减少而增加,CD4细胞<200个/μL组病人的静息心率(88.53±16.78)bpm高于CD4细胞200~500个/μL组病人的静息心率(82.14±13.12)bpm(P <0.05);病例组亚组中,QTc间期随HIV核糖核酸(RNA)载量的升高而延长,HIV RNA载量> 5拷贝/mL组病人的QTc间期(418.29±17.96)ms较HIV RNA载量<4拷贝/mL组病人的QTc间期(407.41±23.29)ms延长(P <0.05)。结论初发HIV感染男性病人的静息心率较健康男性增加,QTc间期较健康男性无明显延长,免疫功能水平低下时静息心率增加,高HIV RNA载量时QTc间期延长。

Objective To analyze the characteristics of the resting heart rate and QTc interval length in initial HIV of males by 12 lead electrocardiogram(ECG). Methods We collected the male HIV patients first diagnosed at Beijing Ditan hospital affiliated to Capital Medical University, and selected male healthy volunteers as a control group. The differences of resting heart rate, QRS interval and QTc interval between the two groups were compared by ECG. CD4^+ T cell count and HIV viral load were classified, and the differences of resting heart rate, QRS interval and QTc interval between subgroups were compared. Results A total of 154 male patients and healthy volunteers were enrolled in the study. 17 patients(11.04%) and 2 volunteers(1.30%) had prolonged QTc(P > 0.05). The resting heart rate of the case group was significantly higher than that of the healthy group,(P < 0.05). The resting heart rate(88.53±16.78) bpm of the patients with CD4^+ T lymphocyte count< 200/μL was higher than that of the patients with CD4^+ T lymphocyte count 200-500/μL(82.14±13.12) bpm,(p < 0.05). In the subgroup, the QTc interval(418.29±17.96) ms in the group with HIV viral load > 5 lg copies per milliliter was prolonged compared with that in the group with HIV viral load < 4 lg copies per milliliter(407.41±23.29) ms,(P < 0.05). Conclusion The resting heart rate of male patients with initial HIV infection is higher than that of healthy men, and the resting heart rate increases significantly when the immune function level is low. There is no significant difference in the QTc interval between the two groups, while the QTc interval is prolonged when the HIV viral load is high. HIV-positive male patients may be at higher risk of sudden cardiac death due to ventricular arrhythmia secondary to QTc prolongation.