维持性血液透析患者QTc间期与人体成分分析的相关性研究

Study on correlation between QTc interval and body composition analysis in maintenance hemodialysis patients

目的研究维持性血液透析(MHD)患者QTc间期与人体成分之间的相关性。方法选取2020年1—12月在郑州大学第一附属医院肾脏内科住院治疗的305例MHD患者,其中QTc间期正常组与延长组分别为183例(60%)及122例(40%)。在周中透析日透析前利用多频生物电阻抗人体成分分析仪进行人体成分分析,记录透析前水负荷(OH)、脂肪组织指数(FTI)、瘦肉组织指数(LTI)、人体总水分(TBW)、细胞外液(ECW)、细胞内液(ICW)、体细胞质量(BCM)、体质量指数(BMI),同期进行实验室检查、心电图检查。根据QTc间期将患者分为QTc间期延长组(QTc间期>440 ms)及QTc间期正常组(340 ms≤QTc间期≤440 ms),比较两组间各临床指标及人体成分分析指标的差异,分析各临床指标、人体成分分析指标与QTc间期的相关性,采用逐步多元线性回归分析MHD患者QTc间期延长的相关影响因素。结果与QTc间期正常组相比,延长组患者FTI增加,LTI、TBW、ICW、BCM下降(P<0.05),血小板计数(PLT)、血钙(Ca)相对更低,C反应蛋白(CRP)显著升高(P<0.05)。相关性分析显示,QTc间期与CRP、FTI呈正相关(P<0.05),与Ca、LTI、TBW、ICW、BCM呈负相关(P<0.05)。以QTc间期为因变量,以CRP、Ca、LTI、FTI、TBW、ICW、BCM为自变量进行逐步多元线性回归分析,结果显示,高FTI、低Ca、高CRP为QTc间期延长的独立危险因素(P<0.05)。结论QTc间期延长广泛存在于MHD患者,高FTI、低Ca、高CRP是导致QTc间期延长的独立危险因素。

Objective To study the correlation between QTc interval and body composition in maintenance hemodialysis(MHD)patients.Methods A total of 305 MHD patients who were hospitalized in the Department of Nephrology,The First Affiliated Hospital of Zhengzhou University from January to December 2020 were selected,including 183(60%)normal QTc interval patients and 122(40%)prolonged QTc interval patients,respectively.The multifrequency bioelectrical impedance body composition analyzer was used for body composition analysis before dialysis on the mid week dialysis days.The water load(OH),fat tissue index(FTI),lean tissue index(LTI),total body water(TBW),extracellular water(ECW),intracellular water(ICW),body cell mass(BCM)and body mass index(BMI)before the dialysis were recorded.Laboratory examination and electrocardiogram were performed at the same time.According to the QTc interval,patients were divided into the prolonged QTc interval group(QTc interval>440 ms)and normal QTc interval group(340 ms≤QTc interval≤440 ms),and the differences of clinical indicators and human component analysis indexes between the two groups were compared.The correlation between clinical indicators,human component analysis indexes and QTc interval was analyzed,and the related influencing factors of the prolongation of QTc interval in MHD patients were analyzed by the stepwise multiple linear regression.Results Compared with the normal QTc interval group,in the prolonged QTc interval group,the FTI was increased;the LTI,TBW,ICW and BCM were decreased;the PLT and Ca were lower;CRP was significantly increased(P<0.05).The correlation analysis showed that the QTc interval was positively correlated with CRP and FTI(P<0.05),and negatively correlated with Ca,LTI,TBW,ICW and BCM(P<0.05).With the QTc interval as the dependent variable and CRP,Ca,LTI,FTI,TBW,ICW and BCM as independent variables,stepwise multiple linear regression analysis showed that high FTI,low Ca and high CRP were the independent risk factors of the QTc interval prolongation(P<0.05).Conclusion The QTc interval prolongation is widely found in MHD patients,and high FTI,low Ca and high CRP are independent risk factors for the QTc interval prolongation.