主动脉弓钙化维持性血液透析患者QT离散度、心率变异性和心室晚电位变化的临床研究

Clinical study of QT dispersion, heart rate variability and ventricular late potentials in patients with aortic arch calcification maintenance hemodialysis

目的探讨主动脉弓钙化维持性血液透析患者QT离散度、心率变异性和心室晚电位变化。方法选择2014年1月~2017年12月广东医科大学附属第三医院进行维持性血液透析治疗的患者52例,根据患者是否存在主动脉弓钙化将其分为钙化组和非钙化组。比较两组患者的基本临床指标、QT离散度、心率变异性指标和心室晚电位。结果钙化组患者35例,非钙化组患者17例。与非钙化组比较,钙化组患者平均年龄更大,透析龄更长,平均脉压差更高,差异有统计学意义(P<0.05);钙化组患者的QT离散度(QTd)、校正的QT离散度(Q-Tcd)和二尖瓣舒张早期血流峰值与二尖瓣环舒张早期运动速度之比(E/E')值显著高于非钙化组,差异有统计学意义(P<0.05)。两组左心室射血分数(EF)值比较,差异无统计学意义(P>0.05);钙化组患者标准化低频功率(LFn)值和功率变异比值[低频功率(LF)/高频功率(HF)比值]均显著低于非钙化组,差异有统计学意义(P<0.05);两组患者标准化高频功率(HFn)值比较,差异无统计学意义(P>0.05)。结论 维持血液透析患者主动脉弓出现钙化会引起心脏QT离散度改变,心率变异性降低,且使得患者更加容易出现心室晚电位。

Objective To investigate the clinical significance of QT dispersion, heart rate variability and ventricular late potentials in patients with aortic arch calcification maintenance hemodialysis. Methods From January 2014 to December 2017, in the Third Affiliated Hospital of Guangdong Medical University, 52 patients with maintenance hemodialysis were selected, according to whether with or without aortic arch calcification, patients were divided into calcification group（35 cases） and non-calcification group（17 cases）. The basic clinical indexes, QT dispersion, heart rate variability index and ventricular late potentials in two groups were compared. Results Compared with the non-calcification group, the average age of the patients in the calcification group was more, the mean duration of dialysis was longer, and the mean pulse pressure difference was higher, the differences were statistically significant（P〈0.05）. The QTd, Q-Tcd and E/E＇ in the calcification group were significantly higher than those in the non-calcification group, the differences were statistically significant（P〈0.05）. There was no significant difference in EF between the two groups（P〉0.05）. The LFn value and LF/HF ratio in the calcification group were significantly lower than those in the non-calcification group, the differences were statistically significant（P〈0.05）. There was no significant difference in HFn values between the two groups（P〉0.05）. Conclusion Maintaining calcification of the aortic arch in hemodialysis patients can causes changes of cardiac QT dispersion, reduced heart rate variability, in order to make a greater likelihood of ventricular late potentials in patients.