肝硬化患者Q-T间期延长及Q-T离散度变化的多因素分析──附73例报告

A multiple regression analysis of Q-T interval prolongation and Q-T dispersion in hepatic cirrhosis

目的:探讨肝硬化患者心电图校正的Q-T间期(Q-Tc)、Q-T离散度(Q-Td)的变化及Q-Tc与肝硬化病因、严重程度、多项生化指标的关系。方法:检测73例肝硬化患者与50例非肝硬化患者心电图Q-Tc、Q-Td、凝血酶原时间(PT)、血清白蛋白(ALB)、血清总胆红素(TBIL)、血钾、血钙等指标,组间比较Q-Tc和Q-Td的变化,并用单因素直线相关、多元回归分析Q-T间期与肝功能Child分级及各项观察指标的关系。结果:肝硬化组Q-Tc为(434±41)ms,而非肝硬化组为(404±31)ms,两组比较P<0.001;肝硬化组Q-Td为(44±37)ms,非肝硬化组(27±10)ms,P<0.001;以Q-Tc等于或超过440ms为异常,肝硬化组Q-Tc的异常率为53%(39/73),非肝硬化组则为14%(7/50)。肝硬化组中ChildC级Q-Tc异常率占75%(9/12),B级占60%(21/35),A级占35%(9/26)。单因素直线相关分析结果,Q-Tc与Child分级呈正相关,相关系数r=0.36(P<0.01);与血钙、血钾、PT,ALB,TBIL等无明显相关。多元回归分析结果,Child-Pugh分级与Q-T间期相关。结论:肝硬化患者心电图Q-T间期延长与Q-Td增大是多种因素综合影响的结果,与肝硬化的病情严重程度相关,鉴于Q-T间期延长及Q-Td增大与严重心律失常及猝死有关,且某些药物对Q-T间期的患者有诱发致命性心律失常的危险。

Objective：To investigate the relationship between abnormal corr ective Q-T interval (Q-Tc) or Q-T dispersion (Q-Td) and the etiology and sev erity of liver disease，possible causes of Q-Tc，or Q-Td. Methods：Seventy-th ree cases of hepatic cirrhosis and 50 control subjects were studied. Rate-corre cted Q-Tc and Q-Td，liver function tests，Child-Pugh score and electrolytes w ere assessed. Correlation coefficiencies were derived by linear regression analy sis. Variables were correlated with Q-Tc by multiple regression analysis. Resul ts：Q-Tc was longer in patients with cirrhosis than that in controls [(434±41) ms vs (404±31) ms，P<0.001] and prolonged in 39 patients (53％) and in 7 contr ols (14％，P<0.01). Q-Td was (44±37) ms in patients (n=32) and (27±10) ms in controls (P<0.001). Multiple regression analysis showed only Child-Pugh score w as independently correlated with Q-Tc duration. Conclusion：Q-T interval and Q -T dispersion are frequently prolonged in patients with cirrhosis and worsens i n parallel with the severity of the disease. Since abnormal Q-Tc and Q-Td may be correlated with severe arrhythmia and sudden death，close monitor of ECG chan ges in severe cirrhotic patients is necessary.