心电图Q-T离散度对维持性血液透析患者发生心血管事件的预测价值

Predictive Value of Q-T Dispersion of Electrocardiogram for Occurrence of Cardiovascular Events in Patients with Maintenance Hemodialysis

【目的】探讨心电图Q-T离散度(QTd)对维持性血液透析(MHD)患者发生心血管事件的预测价值。【方法】选取在本院进行治疗的182例MHD患者为研究对象。随访1年,统计MHD患者发生心血管事件情况,并依据是否发生心血管事件,分为发生组和未发生组。对比两组患者的临床资料,Logistic多因素回归分析影响MHD患者发生心血管事件的相关因素。制作受试者工作特征曲线(ROC),分析QTd对MHD患者发生心血管事件的预测效能。【结果】本研究心血管事件的发生率为23.63%(43/182)。发生组透析龄、血肌酐、血磷、胱抑素C及QTd均显著高于未发生组(P<0.05),发生组残肾滤过率则显著低于未发生组(P<0.05)。Logistic回归分析结果显示,残肾滤过率、胱抑素C及QTd均为MHD患者发生心血管事件的影响因素(OR=3.133、2.776、3.554,P<0.05)。ROC分析显示,心电图QTd预测MHD患者发生心血管事件的最佳截断点分别为62.78 ms,灵敏度、特异度及曲线下面积(AUC)分别为62.79%、75.54%、0.744。【结论】心电图QTd对MHD患者发生心血管事件的预测效能较高,可作为预测MHD患者发生心血管事件的重要参考指标。

【Objective】To explore the predictive value of electrocardiogram Q-T dispersion(QTd)for cardiovascular events in maintenance hemodialysis(MHD)patients.【Methods】A total of 182 patients with MHD who were treated in our hospital were selected as the research objects.During the 1-year follow-up,the cardiovascular events of MHD patients were counted and divided into the occurrence group and the non-occurring group according to whether a cardiovascular event occurred.Clinical data of patients in the occurrence group and the non-occurrence group were compared.Logistic multivariate regression was analyzed for related factors affecting cardiovascular events in MHD patients.The receiver operating characteristic curve(ROC)was drawn to analyze the predictive power of electrocardiogram QTd for cardiovascular events in MHD patients.【Results】The incidence of cardiovascular events in this study was 23.63%(43/184).The dialysis age,blood creatinine,blood phosphorus,cystatin C and QTd of the occurrence group were significantly higher than those of the non-occurring group(P<0.05),and the residual kidney filtration rate of the occurrence group was significantly lower than that of the non-occurring group(P<0.05).Logistic regression analysis showed that residual kidney filtration rate,cystatin C and QTd were the influencing factors of cardiovascular events in MHD patients(OR=3.133,2.776,3.554,respectively,P<0.05).ROC analysis showed that the best cut-off points of ECG QTd for predicting cardiovascular events in MHD patients were 62.78 ms,and the sensitivity,specificity and area under the curve(AUC)were 62.79%,75.54%,and 0.744,respectively.【Conclusion】Electrocardiogram QTd has a high predictive power for cardiovascular events in MHD patients,and can be used as an important reference index for predicting cardiovascular events in MHD patients.