肝硬化患者Q-T间期延长的临床观察

Clinical investigation of Q-T prolongation in hepatic cirrhosis

目的探讨肝硬化患者心电图 Q-T 间期(Q-Tc)延长与肝硬化的严重程度及预后的相互关系。方法对126例肝硬化患者及126例健康对照的心电图 Q-Tc 进行比较;肝硬化患者按Child-Pugh 分级后,观察各级间心电图 Q-Tc、凝血酶原时间(PT)、血清白蛋白(ALB)、血清总胆红素(TBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)、血清钾、血清钙等指标;观察20例肝硬化晚期行肝移植手术患者手术前后的心电图 Q-Tc 及上述生化指标。结果肝硬化患者的 Q-Tc 较健康对照明显延长(P<0.01);肝硬化患者各级间 Q-Tc 随 Child分级呈现逐渐增高趋势,A 级与 B、C 级 Q-Tc 差异有统计学意义(均 P<0.01),B、C 级之间差异无统计学意义;直线相关分析 Q-Tc 与 Child 积分呈正相关(r=0.56,P<0.05);20例术前 Q-T 延长的肝移植患者术后17例患者 Q-Tc 恢复正常,3例患者明显较术前缩短。结论肝硬化患者存在 Q-Tc 延长,且随着病情的严重程度增加,Q-Tc 异常率增高。肝移植后往往恢复正常。Q-Tc 延长在判定肝硬化患者病情程度及预后上有重要的临床意义。

Objective To investigate the relationship between the prolonged corrected QT interval （Q-Tc） and the severity and prognosis of patients with hepatic cirrhosis. Methods Electrocardiography was conducted on 126 patients with hepatic cirrhosis, 86 males and 40 females, aged （62 ± 16 ）, 38 of Child- Pugh grade A, 64 of grade B, and 24 of grade C, and 126 sex- and aged-matched healthy persons as controls. Peripheral blood samples were collected to undergo the examination of prothrombin time, and serum albumin, total bilirubin, potassium, calcium, ALT, AST, gamma glutamyl transferase, and alkaline phosphatase. The relationship between the Q-Tc and other parameters were analyzed. Twenty cirrhotic patients underwent liver transplantation. Results The Q-Tc value of the cirrhosis patients was （421 ± 38 ） ms, significantly longer than that of the controls （386 ± 25 ） ms. The Q-Tc prolongation rate of the cirrhosis patients was 46.93% （58/126）, significantly higher than that of the controls （ 1.58%, 2/126, P 〈0.01 ）. The Q-Tc prolongation rates of the patients of Child-Pugh grade B and C were 56. 89% and 59.60% respectively, both significantly higher than that of the patients of grade A （21.05%, both P 〈 0.01 ）. Linear regression analysis showed that Q-Tc was positively correlated with the Child-Pugh score. Q-Tc was not significantly correlated with the biochemical indicators mentioned above. The prolonged Q-Tc became normal in 17 of the 20 patients undergoing liver transplantation and became shorter in 3 cases one year after the operation. Conclusion Q-Tc prolongation exits in hepatic cirrhosis and the Q-Tc prolongation rate increases along with the severity of disease. After liver transplantation the prolonged Q-Tc may recover to normal Q-Tc prolongation can be used to assess the severity and prognosis of hepatic cirrhosis.