慢性肾脏病与QRST夹角相关性

Association of electrocardiographic QRST angle with chronic kidney disease among middle aged and elderly rural residents

目的探索慢性肾脏病(CKD)与心电图QRST夹角关系。方法于2017年9月,在辽宁省朝阳市农村随机选择≥40岁农村居民作为研究对象,进行问卷调查、体格检查、心电图检查和血液检查。通过CKD-EPI公式计算估计肾小球滤过率(eGFR);通过12导联心电图获取平面QRST夹角,平面QRST夹角以95%分位(79°)作为分割点进行分组,>79°定义为异常。采用logistic回归分析慢性肾脏病与QRST夹角异常的相关性。结果在最终纳入研究的4258人中,CKD患者共69例(1.62%),与非CKD组比较,CKD组患者QRST夹角增大(26°vs18°,P<0.05);调整血钾、甘油三酯、高密度脂蛋白、收缩压、心率、吸烟、腰围、血红蛋白、脑梗死等影响因素后,慢性肾脏病是QRST夹角异常的独立危险因素(OR=2.32,95%CI=1.06~5.04)。结论在普通人群中,慢性肾脏病与心电图平面QRST夹角异常显著相关,平面QRST夹角可预测慢性肾脏病进程。

Objective To explore the association between electrocardiographic QRST angle and chronic kidney disease (CKD) in middle aged and elderly rural populations.Methods We conducted a cross-sectional survey, including questionnaire interview, physical examination, and electrocardiogram and blood tests, among 4 258 rural residents aged 40 years and older recruited with cluster sampling in 16 villages of Chaoyang municipality, Liaoning province in September 2017. The estimated glomerular filtration (eGFR) of the participants was calculated with CDK-epidemiology collaboration (CDK-EPI) formula and the participants with the eGFR of < 60 ml/minute/1.73 m2 CDK were considered as with renal insufficiency. The plane QRST angle was obtained with a 12-lead electrocardiogram (ECG), and the cut-off point of QRST angle is 95% quintile (79°) and the values greater than 79° were judged as abnormal QRST angle. The correlation between CDK and QRST angle was assessed with logistic regression analysis.Results Of all the participants, 69 (1.62%) were identified with CKD. A significant greater QRST angle was observed among the participants with CKD than among those without CDK (26° vs. 18°, P < 0.05). Abnormal QRST angle was a independent risk factor for CDK after adjusting for serum potassium, triglyceride, high-density lipoprotein cholesterol, systolic blood pressure, heart rate, smoking, waist circumference, hemoglobin, and cerebral infarction (odds ratio = 2.32, 95% confidence interval: 1.06-5.04).Conclusion Increased electrocardiographic QRST angle is significantly associated with chronic kidney disease in general population and plane QRST angle could be used as a predicator for the process of chronic kidney disease.