成年1型糖尿病患者QTc间期延长检出率及影响因素研究

Prevalence and Associated Factors of Prolonged QTc Interval among Adult Patients with Type 1 Diabetes Mellitus

目的了解成年1型糖尿病患者QTc间期延长检出率,并探讨其危险因素。方法选取2007—2016年中山大学附属第一医院内分泌科收治的1型糖尿病患者166例。根据同步12导联心电图检查结果,将患者分为QTc间期延长组(n=63,QTc间期>0.44 s)和QTc间期正常组(n=103,QTc间期≤0.44 s)。QTc间期采用Bazett公式计算。比较两组患者一般资料和实验室检测指标。采用多因素Logistic回归分析探讨QTc间期延长的影响因素。结果1型糖尿病患者QTc间期延长的检出率为38.0%(63/166)。QTc间期延长组女性患者比例、年龄、病程、慢性并发症[糖尿病肾病(DN)、糖尿病周围神经病变(DPN)、糖尿病视网膜病变(DR)]发生率高于QTc间期正常组,体质指数(BMI)低于QTc间期正常组,差异有统计学意义(P<0.05);两组患者吸烟率、饮酒率、腰臀比、血压[收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)]比较,差异无统计学意义(P>0.05)。QTc间期延长组患者糖化血红蛋白(Hb A_(1c))水平高于QTc间期正常组,差异有统计学意义(P<0.05);两组患者血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)、肌酐(Cr)、尿素氮(BUN)比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,性别、年龄、DPN、BMI、Hb A_(1c)是1型糖尿病患者QTc间期延长的影响因素(P<0.05)。结论成年1型糖尿病患者QTc间期延长发生率较高,女性、高龄、并发DPN、低BMI、高Hb A_(1c)是1型糖尿病患者QTc间期延长的危险因素。监控其危险因素,及时识别QTc间期延长,早期进行干预将有助于改善高危患者的预后。

Objective The aim of this study was to evaluate the prevalence and risk factors of prolonged QTc interval in adult patients with type 1 diabetes mellitus(DM).Methods A total of 166 inpatients with type 1 DM who received treatment in Department of Endocrinology,The First Affiliated Hospital,Sun Yat-sen University during the period from 2007 to 2016,were enrolled in this study.The patients were divided into prolonged QTc group(n=63,QTc interval>0.44 s)and normal QTc group(n=103,QTc interval≤0.44 s)according to the 12-lead ECG synchronized recordings,and the QTc interval was calculated using Bazett formula.Baseline characteristics and laboratory findings were compared between the two groups.Multivariate Logistic regression analysis was performed to explore the influencing factors of prolonged QTc interval.Results The prevalence of prolonged QTc interval among the patients with type 1 DM was 38.0%(63/166).Compared with the patients with normal QTc interval,those with prolonged QTc interval were older,and they had higher proportion of females,longer duration of DM,higher prevalence of chronic complications〔diabetic nephropathy(DN),diabetic peripheral neuropathy(DPN),diabetic retinopathy(DR)〕,but lower average BMI(P<0.05).There were no significant differences in smoking rate,drinking rate,waist-hip ratio,systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)between the two groups(P>0.05).No significant differences in serum levels of total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),uric acid(UA),creatinine(Cr)and blood urea nitrogen(BUN)were found between the two groups(P>0.05),while glycosylated hemoglobin(HbA1c)level of prolonged QTc interval group was significantly higher than that of normal QTc interval group(P<0.05).Multivariate Logistic regression analysis showed that sex,age,DPN,BMI and HbA1c were the influencing factors of QTc prolongation in type 1 diabetic patients(P<0.05).Conclusion Prolongation of QTc interval in patients with type 1 DM is very common.Female,aging,decreased BMI,prevalence of DPN and increased HbA1c are risk factors for QTc prolongation in these patients.Monitoring the risk factors,timely detection of prolonged QTc interval,and early intervention will help to improve the prognosis of high-risk patients.