2型糖尿病患者校正QT间期延长与多种心血管危险因素的相关性

Relationship of prolonged QTc interval and multi-cardiovascular risk factors in patients with type 2 diabetes mellitus

目的分析QTc延长与多种心血管危险因素的关系。方法除外影响QTc因素的患者后,收集完成糖尿病并发症筛查和12导联心电图检查的数据。根据QTc正常与否(QTc<0.44 s为正常,QTc≥0.44s为延长),将患者分为正常组和延长组。比较和分析两组患者的多种心血管危险因素。结果入选2型糖尿病患者3426例,其中37%的患者合并有QTc延长。与正常组相比,延长组患者年龄大、糖尿病病程长、女性比例高、腰围和腰臀比大、血压高、心率快,糖化血红蛋白(HbA1c)、餐后2小时血糖、空腹胰岛素、血胆固醇和甘油三酯以及尿白蛋白/肌酐比值高。Logistic回归分析显示,年龄、性别、体质量指数、腰围、腰臀比、心率和血肌酐与QTc延长明显相关。结论略多于1/3的2型糖尿病患者合并QTc延长,并有更多更严重的多种心血管疾病危险因素。

Objective To investigate the relationship between the prolonged QTc interval and the multi-cardiovascular risk factors in patients with type 2 diabetes mellitus（T2DM）. Methods Medical data of 3940 T2DM patients were analyzed. After patients who had coronary heart diseases, arrhythmia, myocardial infarction, which may cause abnormal QTc, were excluded, a total of 3426 T2DM patients who had underwent diabetic complication assessment and 12 standard electrocardiogram（ECG） recording were enrolled. They were divided into normal QTc interval group（QTc 〈 0.44 s, n=2157） and prolonged QTc interval group（QTc≥ 0.44s, n= 1269）. The multi-cardiovascular risk factors were compared between the two groups and further analyzed. Results Compared with normal QTc interval group, the patients in prolonged QTc interval group were older[（55.6 ± 11.0） vs （54.6±10.9） years], had longer diabetes duration[36（12, 96） vs 36（6, 84）months, median（P25, P75）], more females （51.5% vs 41.5%）, shorter body height[ （1.64± 0.08） vs （1.65 ± 0.08） m], bigger body mass index（BMI）[（26.2±3.6） vs （25.8 ± 3.2）kg/m2], bigger waist circumference[（89.7 ± 9.6） vs （88.2 ± 9.5） cm], bigger hip circumference[（95.4 ±7.3） vs （94.4 ± 6.6）cm], higher waist hip ratio（WHR）[（0.94 ±0.07） vs （0.93 ±0.08）], higher blood pressure [（134.8 ± 20.3）/（76.9 ± 10.2） vs （130.1 ± 19.1）/（74.5 ± 9.6）mmHg], increased heart rate [（82.9± 10.2） vs （70.7 ± 10.1）beats/min], higher HbAlc [（8.0 ± 2.0）% vs （7.7 ± 1.9）%], higher post-meal glucose[（13.7 ± 5.1） vs （12.8± 4.8）mmol/L], higher fasting insulin[（9.4 ± 8.6） vs （8.2 ±7.5）IU/ml], increased total cholesterol[（5.1± 1.1） vs （5.0 ± 1.1）mmol/L], higher triglyceride [（2.4 ± 2.6） vs （2.2 ± 2.5）mmol/L], and higher urine albumin/creatinine（Alb/Cr）[15（8, 36） vs 12 （7, 27）mg/g, median（P25, P75）]. All these indices were significantly different between the two groups（P 〈 0.05）. Logistic regression analysis showed that factors including age, sex, BMI, waist circumference, WHR, heart rate and Cr, were significantly associated with prolonged QTc interval. Conclusions More than one third of T2DM patients present with prolonged QTc interval and more severe multi-cardiovascular risk factors.