QT离散度在急性肺栓塞中的临床意义

QT dispersion in acute pulmonary embolism

目的:探讨急性肺栓塞患者的QT离散度变化及临床意义。方法:收集2011年5月至2012年4月中南大学湘雅医院急性肺栓塞患者42例,根据入院时情况分为高危组(16例)和非高危组(26例),以年龄与性别匹配的同时期健康体检者30例为正常对照组。肺栓塞患者入院24 h内及治疗后分别行同步十二导联心电图检查,手工测量QT间期,并计算出QT离散度(QT dispersion,QTd)及心率校正的QT离散度(heart rate-corrected QT dispersion,QTcd)。短期随访患者住院期间生存情况,根据生存情况分为生存组(31例)及死亡组(11例)。结果:QTd及QTcd在高危组[(70.2±34.0),(88.1±43.3)ms]及非高危组[(49.3±21.8),(59.1±26.2)ms]均显著大于正常对照组[(33.2±12.4),(36.7±14.2)ms](P<0.05);高危组又显著大于非高危组(P<0.05)。前后两次心电图间隔为(5.6±2.5)d,治疗后生存组QTd及QTcd[(41.0±16.4),(47.4±18.0)ms]较入院时[(54.0±33.0),(67.2±40.5)ms]显著减小(P<0.05),但仍大于正常组(P<0.05),死亡组治疗前后QTd及QTcd差异无统计学意义(P>0.05)。多元logistic回归分析表明:入院时高危、存在右室功能障碍、治疗后QTcd仍大于正常范围是住院期间死亡的主要影响因素。结论:急性肺栓塞患者QTd及QTcd增大;合并右室功能障碍、入院时危险度高及治疗后QTcd大于正常范围者住院期间短期预后不良。

Objective： To explore the alteration and the clinical significance of QT dispersion in acute pulmonary embolism （PE）. Methods： From May 2011 to April 2012, 42 hospitalized PE patients in Xiangya Hospital of Central South University were enrolled, and divided into a high-risk group and a non-high-risk group according to the clinic state on admission. Another 30 healthy subjects with matched age and genders were enrolled as a normal control group. Q.T interval was measured manually in 12- lead conventional electrocardiogram within 24 hours on admission and after the treatment. Q.T dispersion （Q.Td） and heart rate-corrected O.T dispersion （Q.Tcd） were also calculated. All patients were followed up during hospitalization, and were divided to a death group and a survival group. Results： O.Td and Q.Tcd in the high-risk group [（70.2±34.0）, （88.1±43.3） ms] and the non-highrisk group [（49.3±21.8）, （59.1±26.2） ms] were significantly higher than those in the normal control group[（33.2±12.4）, （36.7±14.2） ms] （P〈0.05）, while Q Td and q.Tcd in the high-risk group were significantly higher than those in the non-high-risk group （P〈0.05）. The interval of electrocardiogram was （5.6±2.5） days between 24 hours on admission and after the treatment （ECG）. Q.Td and Q Tcd were reduced significantly after the treatment in the survival group [（41.0±16.4）, （47.4±18.0）ms] compared with those on admission [（54.0±33.0）, （67.2±40.5）ms] （P〈0.05）, but the Q Td and Q.Tcd after the treatment were also significantly higher than those in the normal control group （P〈0.05）. There was no significant difference in the Q Td and Q Tcd between 24 hours on admission and after the treatment in the death group （P〉0.05）. Logistic regression showed that high-risk of PE, right ventricular the main risk factors of hospital death. dysfunction and high Q.Tcd after the treatment were Conclusion： Q.Td and Q Tcd are increased in PE. PE patients with right ventricular dysfunction, high-risk of PE, and high Q Tcd after the treatment suggest weak prognosis.