肺动脉高压患者心率校正QT间期和QT离散度的研究

Study of heart-rate corrected QT interval and QT dispersion in patients with pulmonary hypertension

目的:检测肺动脉高压(pulmonary hypertension,PH)患者的心率校正的QT间期(heartrate-corrected QT interval,QTc)和QTc离散度(QTc dispersion,QTcd),并评价其与肺动脉压力的关系。方法:入选2003年12月至2008年7月因初步诊断为PH而进行右心导管术的患者。记录静息12导联心电图,手工测量QT间期并用Bazett公式进行校正。根据平均肺动脉压,将患者分为对照组,轻-中度PH组和重度PH组。结果:共入选201例患者。男性患者的QTc和QTcd在3组间差异无统计学意义。女性患者中,重度PH组的QTc比对照组高〔(436.1±39.4)msvs.(407.6±24.8)ms,P=0.037〕,重度PH组的QTcd(68.5±20.9)ms高于对照组(45.1±12.6)ms和轻-中度组(58.6±14.7)ms(P=0.002;P=0.003)。此外,女性患者的QTc和QTcd与平均肺动脉压正相关(r=0.207,P=0.03;r=0.236,P=0.012)。结论:本组资料中女性PH患者的QTc和QTcd与平均肺动脉压正相关,且在重度PH患者中显著增高,有待于进一步探讨。

Objective：To examine heart rate-corrected QT interval（QTc） and QTc dispersion（QTcd） in pulmonary hypertension and assess their relationship with pulmonary arterial pressure.Methods：From December 2003 to July 2008,201 patients who had undergone right heart catheterization for a preliminary diagnosis of pulmonary hypertension were included in the study.Resting 12-lead electrocardiogram was recorded.QT interval was measured manually and corrected using Bazett＇s formula.Patients were divided into three groups according to mean pulmonary arterial pressure：control,mild-to-moderate pulmonary hypertension and severe pulmonary hypertension.Results：In all observed cases,mean QTc was higher in severe pulmonary hypertension than that in controls 〔（428.6 ± 32.8） ms vs.（411.1 ± 28.4） ms,P = 0.018〕and QTcd was higher in mild-to-moderate（60.1 ± 17.2） ms and severe pulmonary hypertension（63.9 ± 20.5） ms than that in controls（47.3 ±10.6） ms（P =0.031;P =0.004）.In men,there was no significant difference in mean QTc and QTcd.In women,mean QTc was higher in severe pulmonary hypertension than that in controls 〔（436.1 ± 39.4） ms vs.（407.6 ± 24.8） ms,P = 0.037）〕and QTcd was higher in severe pulmonary hypertension（68.5 ±20.9） ms than that in both the controls（45.1 ±12.6） ms and patients with mild-to-moderate pulmonary hypertension（58.6 ± 14.7） ms（P = 0.002;P = 0.003）.In addition,in women with pulmonary hypertension,mean QTc and QTcd were positively correlated to mean pulmonary arterial pressure（r = 0.207,P = 0.03;r = 0.236,P = 0.012）.Conclusion：In women with pulmonary hypertension,mean QTc and QTcd are positively correlated to mean pulmonary arterial pressure and are significantly increased in patients with severe pulmonary hypertension.