美沙拉嗪对炎症性肠病患者心电图特征影响的分析

Influence of mesalazine on electrocardiographic characteristics in patients with inflammatory bowel disease

目的探讨美沙拉嗪治疗对炎症性肠病(IBD)患者心电图特征的影响。方法选取2016年12月至2018年5月于武汉大学人民医院消化内科收治的急性IBD患者为观察组(n=118),给予美沙拉嗪肠溶片0.5 g口服,3/d,连续服药8周;选取同期入院且病程为8周的IBD患者(来院前曾于外院就诊,但未明确诊断且未给予针对性药物干预)为病例对照组(n=27);另选取同期来院体检的健康体检者为健康对照组(n=118)。3组均行标准12导联心电图,比较观察组治疗前后,观察组治疗后与健康对照组,观察组治疗后与病例对照组的白细胞计数(WBC)、C反应蛋白(C-RP)、红细胞沉降率(ESR)、电解质水平、P波离散度和QT间期等指标。结果与观察组治疗前相比,治疗后WBC、C-RP和ESR均明显降低(P<0.05),血钾、血钙和血镁水平均明显升高(P<0.05),P波时限、QTc、P波离散度、QT间期离散度和QTc离散度均无明显差异(P>0.05)。与健康对照组相比,观察组治疗后WBC、C-RP、ESR、血钾、血钙和血镁水平无明显差异(P>0.05),P波时限(min)和QTc明显增大(P<0.05),P波时限(max)、P波离散度、QT间期离散度和QTc离散度明显减小(P<0.05);与病例对照组相比,观察组治疗后WBC、C-RP和ESR明显降低(P<0.05),血钾、血钙和血镁水平明显升高(P<0.05),P波时限(min)、QTc(min)、P波时限(max)、P波离散度、QT间期离散度和QTc离散度均无明显差异(P>0.05)。结论IBD患者有严重心律失常风险,即使在美沙拉嗪治疗后处于缓解期时亦会出现心律失常,应不定期监测心电图。

Objective To discuss the influence of mesalazine on electrocardiographic characteristics in patients with inflammatory bowel disease(IBD).Methods IBD patients(n=118)were chosen into observation group(treated with mesalazine in 0.5 g/time,3/d for 8 weeks)from Department of Gastroenterology in Renmin Hospital of Wuhan University from Dec.2016 to May 2018.In the same period,IBD patients(n=27)with 6-week disease course were chosen into case control group(visited doctors in other hospital without definite diagnosis and targeted drug intervention).The healthy controls(n=118)with physical examinations were chosen into healthy control group.All 3 groups were given examination of 12-lead electrocardiography(ECG),and indexes of white blood cell count(WBC),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),electrolyte level,P wave dispersion and QT interval were compared among 3 groups before and after treatment.Results The levels of WBC,C-RP and ESR decreased significantly(P<0.05)and levels of potassium,calcium and magnesium in blood increased significantly(P<0.05),and P wave duration,QTc,P wave dispersion,QT interval dispersion and QTc dispersion had no significant difference(P>0.05)in observation group after treatment than before.WBC,C-RP,ESR and levels of potassium,calcium and magnesium in blood had no significant difference(P>0.05),and P wave duration(min)and QTc increased significantly(P<0.05),and P wave duration(max),P wave dispersion,QT interval dispersion and QTc dispersion decreased significantly(P<0.05)in observation group compared with healthy control group after treatment.WBC,C-RP and ESR decreased significantly(P<0.05),levels of potassium,calcium and magnesium in blood increased significantly(P<0.05),and P wave duration(min),QTc(min),P wave duration(max),P wave dispersion,QT interval dispersion and QTc dispersion had no significant difference(P>0.05)in observation group compared with case control group after treatment.Conclusion IBD patients have risk of severe arrhythmia even in remission stage after treatment with mesalazine,so ECG should be monitored for them irregularly.