炎症性肠病患者心电图QT间期变化及其临床意义

Changes of electrocardiographic QT interval in patients with inflammatory bowel disease and clinical significance

目的分析炎症性肠病(IBD)患者心电图QT间期变化及临床意义。方法选择2020年3月至2021年3月金华市中心医院85例IBD患者,根据病情程度分为轻度组34例、中度组29例和重度组22例,另择同期35名健康体检者作为对照组,比较4组对象一般资料、C反应蛋白(CRP)、降钙素原、红细胞沉降率(ESR)、心电图QT间期、QT离散度、QTc离散度,分析QT间期变化与炎症因子及IBD疾病活动度指数的相关性,ROC曲线评估心电图特征参数预测3个月内发生恶性心律失常(MA)的效能。结果重度组CRP、降钙素原、ESR水平及QT间期、QT离散度、QTc离散度均高于中度组、轻度组,中度组均高于轻度组,且均高于对照组(均P<0.05);IBD患者QT间期、QT离散度、QTc离散度与CRP、降钙素原、ESR水平均与疾病活动度指数呈正相关(均P<0.05);IBD患者MA发生率为14.12%,MA患者QT间期、QT离散度和QTc离散度高于无MA患者,差异均有统计学意义(均P<0.05),这3项指标均为IBD患者发生MA的影响因素(均P<0.05)。QT间期、QT离散度和QTc离散度预测MA发生的AUC分别为0.701、0.721、0.828,3者联合预测的AUC为0.891。结论IBD患者QT间期变化与炎症反应密切相关,QT间期变化明显者发生MA的风险较高。

Objective To explore the changes of electrocardiographic QT interval in patients with inflammatory bowel disease(IBD)and its clinical significance.Methods Clinical data of 85 IBD patients in Jinhua Municipal Central Hospital from March 2020 to March 2021 were retrospectively analyzed.According to the severity of the disease,the patients were divided into mild group(34 cases),moderate group(29 cases)and severe group(22 cases).Another 35 healthy subjects were selected as a control group.General data,C-reactive protein(CRP),procalcitonin,erythrocyte sedimentation rate(ESR),QT interval,QT dispersion,QTc dispersion were compared between groups.The association of QT interval changes with inflammatory factors and IBD disease activity index was analyzed,while ECG characteristics were evaluated by ROC curve,the value of QT interval in predicting malignant arrhythmias(MA)within three months were analyzed.Results CRP,procalcitonin,ESR,QT interval,QT dispersion and QTc dispersion were significantly higher in severe,moderate and mild groups than in the control group,in severe group than in moderate and mild groups,and in moderate group than in mild group(all P<0.05).QT interval,QT dispersion and QTc dispersion were positively correlated with CRP,procalcitonin,ESR and disease activity index(all P<0.05).The incidence of MA was 14.12%in IBD patients.QT interval,QT dispersion and QTc dispersion were significantly higher in patients with than without MA(all P<0.05),and were significantly correlated with the occurrence of MA(P<0.05).The area under the curve(AUC)of QT interval,QT dispersion and QTc dispersion for predicting MA occurrence was 0.701,0.721 and 0.828,respectively,and the AUC of combined three parameters was 0.891.Conclusion QT interval variations are closely related to inflammatory reaction in IBD patients. The risk of MA is higher in patients with significant changes of QT interval.