初诊急性白血病患者炎症反应与心电图异常改变的关系

Relationship between inflammatory response and abnormal electrocardiogram changes in patients with newly diagnosed acute leukemia

目的分析初诊急性白血病患者发生心电图异常改变的类型,及炎症反应与其关系的可能机制。方法选取2003年1月至2015年10月北京大学人民医院初诊急性白血病的住院患者203例(其中合并心电图异常改变172例),回顾性分析心电图异常改变的类型,及白细胞、C反应蛋白(CRP)等炎症指标与其的关系。结果初诊急性白血病患者发生心电图异常改变以QTc间期延长最常见(69. 8%),其次为窦性心动过速(26. 7%)和束支传导阻滞(16. 9%)。单因素分析显示,白细胞计数、CRP水平、中性粒细胞绝对值、单核细胞绝对值是急性白血病患者发生心电图异常改变的危险因素(均为P <0. 05)。其中白细胞计数(OR=0. 932,95%CI:0. 870～0. 999,P=0. 048)、单核细胞绝对值(OR=2. 141,95%CI:1. 093～4. 196,P=0. 027)、CRP(OR=1. 016,95%CI:1. 004～1. 029,P=0. 009)与急性白血病患者发生心电图异常改变呈独立相关。结论急性白血病患者的心电图异常改变中以QTc间期延长最常见,其次为束支传导阻滞和窦性心动过速。白细胞计数、CRP水平和单核细胞绝对值是急性白血病患者发生心电图异常改变的独立危险因素。

Objective To investigate the types of abnormal electrocardiogram（ECG）changes,inflammatory response and possible mechanisms in patients with initially diagnosed acute leukemia. Methods A total of 203 patients of initially diagnosed acute leukemia,in which 172 patients with abnormal electrocardiogram change were enrolled into this study,from January 2003 to October 2015 in Peking University People s Hospital.Types of abnormal ECG change,white blood cell（WBC）,C-reactive protein（CRP）and the interact relationship were retrospectively analyzed. Results The most common abnormal ECG change in acute leukemia patients was prolongation of QTc interval（69.8%）,and followed by sinus tachycardia（26.7%）and bundle branch block（16.9%）.Single factor analysis showed that WBC count,CRP level,neutrophil and monocytes count were the risk factors for abnormal ECG changes（all P 〈0.05）.Among them,WBC count（ OR = 0.932,95% CI ：0.870-0.999, P =0.048）,CRP level（ OR =1.016,95% CI ：1.004-1.029, P =0.009）,monocytes count（ OR =2.141,95% CI ：1.093-4.196, P =0.027）were the independent risk factors associated with abnormal electrocardiographic changes in patients with acute leukemia. Conclusions The most common abnormal ECG change in patients with acute leukemia is prolongation of QTc interval,followed by bundle branch block and sinus tachycardia.Classification of acute leukemia,WBC count,CRP level,and monocytes count are the independent risk factors for abnormal ECG changes in patients with acute leukemia.