复方丹参对肝硬化患者心电图QT间期延长的治疗作用

Study of Q-T interval prolongation and its treatment by composite salvia miltiorrhiza in hepatic cirrhosis

目的 :分析肝硬化心电图 Q T间期 (Q Tc)变化及相关影响因素 ,初步探讨复方丹参对异常延长的 Q Tc有否治疗作用。方法 :检测 14 3例肝硬化患者与 5 0例非肝硬化患者心电图 Q Tc、凝血酶原时间(PT)、血清白蛋白 (AL B)、血清总胆红素 (TBIL)、血清钾、血清钙、丙氨酸转氨酶 (AL T)、天冬氨酸转氨酶(AST)、γ 谷氨酰转移酶 (GGT)和碱性磷酸酶 (AL P)等指标 ,组间比较 Q Tc的变化及肝功能不同 Child分级间 Q Tc异常率 ,采用单因素直线相关及多元回归分析探讨 Q Tc与各项相关指标的关系。37例 Q Tc异常延长而无低钾、低钙血症的肝硬化患者中 19例行常规治疗 ,18例在常规治疗的基础上加复方丹参滴丸口服 ,治疗随访 2个月后比较异常延长的 Q Tc的纠正率。结果 :肝硬化组 Q Tc为 (435± 2 5 ) m s,非肝硬化组为 (40 5± 2 3) ms,2组比较 P<0 .0 0 1;以 Q Tc≥ 4 4 0 m s为异常 ,肝硬化组异常率为 39.90 % (49/14 3) ,非肝硬化组为 14 .0 0 % (7/5 0 ) ,2组比较 P<0 .0 0 1。肝硬化组中 Child C级的 Q Tc异常率为 6 2 .5 0 % (2 0 /32 ) ,B级为 4 0 .5 0 % (17/42 ) ,A级为 2 9.0 0 % (2 0 /6 9) ;A级与 C级比较 P<0 .0 1。单因素直线相关分析结果显示 ,Q Tc与 Child积分呈正相关 ,相关系数 r=0 .33(P<0 .0 1) ;

Objective:To investigate the relationship between abnormal corrective QT interval (QTc) and the severity of liver disease,and whether the prolonged QTc could be corrected by treatment with composite salvia miltiorrhiza.Methods:One hundred and fortythree cases of hepatic cirrhosis and 50 control subjects were studied.Ratecorrected QTc,ChildPugh score,electrolytes and hepatic enzymes were assessed by linear regression analysis.Variables were correlated with QTc by multiple regression analysis.Thirtyseven cases of hepatic cirrhosis presenting prolonged QTc (all without hypokalemia hypocalcemia) were divided into two groups;19 of whom were treated with conventional therapy while 18 with conventional therapy combined with composite salvia miltiorrhiza for a period of 2 months and results were compared between these two groups.Results:QTc was longer in patients with cirrhosis than that in controls 〔(435± 25) ms vs.(405±23) ms, P <0 001〕 and prolonged in 49 patients (39 90%) and in 7 controls (14 00%, P <0 001).In cirrhotic group,QTc was prolonged in 20 patients (62 50%) in ChildPugh C,17 (40 50%) in Childpugh B and 20(29 00%) in ChildPugh A subgroup.Linear regression analysis showed QTc was correlated with ChildPugh score and severity of ascites ( r =0 33, P <0 01; r =0 26, P <0 05 respectively).Multiple regression analysis showed ChildPugh scores and PT were independently correlated with QTc.A 2 months period followup study showed prolonged QTc was corrected in 13 out of 18 cases (66 66%) treated with composite salvia miltiorrhiza comparing with 6 out 19 cases (31 58%) with conventional therapy ( P <0 05).Conclusions:QT interval is frequently prolonged in patients with cirrhosis and worsens in parallel with severity of the disease.Correction of prolonged QTc depends on improvement of the disease and composite salvia miltiorrhiza may be helpful in some cases.