标题：维持性血液透析患者心电图QT间期离散度与心血管事件的相关性

      作者：李友河 1，彭翔 2，薛志强 2，曾石养 2    (1.佛冈县人民医院肾内科，广东 佛冈 511600；2.广州医科大学第六附属医院肾内科，广东 清远 511518)

      卷次： 2018年29卷7期

      【摘要】 目的 探讨维持性血液透析(MHD)患者QT间期离散度(QTd)与心脏结构、功能及心血管事件的关系。方法 选取2016年1~8月期间佛冈县人民医院血液净化中心治疗的70例MHD患者为研究对象，根据QTd将患者分为QTd<63 ms组(n=35)和QTd≥63 ms组(n=35)。比较两组患者的左心室心肌质量指数(LVMI)，左心室舒张末内径(LVEDD)、左室射血分数(LVEF)及舒张早期及晚期最大血流速度的比值(E/A)。对患者进行为期12个月的随访，比较两组患者的住院率及心血管事件发生率。结果 QTd≥63 ms组患者的LVMI、LVEDD分别为(155.2±27.4) g/m2、(53.3±5.5) mm，明显高于QTd<63 ms组的(132.6±25.2) g/m2、(47.9±6.1) mm，LVEF、E/A分别为(51.3±6.2)%、(1.08±0.21)，明显低于QTd<63 ms组的(56.8±5.7)%、(1.24±0.32)，差异均有统计学意义(P<0.05)；在随访的12个月内，QTd≥63 ms组患者的住院率为37.14%，心血管事件发生率为28.57%，明显高于QTd<63 ms组的14.29%和8.57%，差异均有统计学意义(P<0.05)。结论 QTd水平可以在一定程度上反映MHD患者心脏结构、功能的变化，对左心室肥厚和功能的评估具有重要意义，并且其与心血管事件的发生关系密切。
      【关键词】 维持性血液透析；QT间期离散度；心血管事件；心脏超声
      【中图分类号】 R459.5 【文献标识码】 A 【文章编号】 1003—6350（2018）07—0905—03

Relationship between electrocardiographic QTd and cardiovascular events in maintenance hemodialysis patients.LI You-he1, PENG Xiang 2, XUE Zhi-qiang 2, ZENG Shi-yang 2.
1. Department of Nephrology, Fogang People's Hospital,Fogang 511600, Guangdong, CHINA; 2. Department of Nephrology, the Sixth Affiliated Hospital of Guangzhou MedicalUniversity, Qingyuan 511518, Guangdong, CHINA
【Abstract】 Objective To investigate the relationship between QT interval dispersion (QTd) and cardiac struc-ture, function and cardiovascular events in maintenance hemodialysis (MHD) patients. Methods During January 2016and August 2016, 70 MHD patients in Blood Purification Center of Fogang People's Hospital, according to the QTd,were divided into QTd<63 ms group (n=35) and QTd≥63 ms (n=35). Echocardiographic indexes, including left ventric-ular mass index (LVMI), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), andthe ratio of early diastolic and late diastolic peak velocity (E/A), were compared between the two groups. The patientswere followed up for 12 months, and the rates of hospitalization and cardiovascular events in the two groups were com-pared. Results LVMI, LVEDD in QTd≥63 ms group were (155.2±27.4) g/m2, (53.3±5.5) mm, respectively, significant-ly higher than (132.6±25.2) g/m2, (47.9±6.1) mm in QTd<63 ms group (P<0.05), and LVEF, E/A was (51.3±6.2)%,(1.08±0.21), significantly lower than (56.8±5.7)%, (1.24±0.32) in QTd<63 ms group (P<0.05). During follow-up of 12months, hospitalization and cardiovascular events rate in the QTd≥63 ms group was 37.14% and 28.57%, significantlyhigher than 14.29% and 8.57% in QTd<63 ms group (P<0.05). Conclusion The level of QTd can reflect the changes ofcardiac structure and function in MHD patients, which is of great significance to assess left ventricular hypertrophy andfunction and is closely related to the occurrence of cardiovascular diseases.
      【Key words】 Maintenance hemodialysis; QT interval dispersion (QTd); Cardiovascular events; Cardiac ultrasound·论 著·doi:10.3969/j.issn.1003-6350.2018.07.006基金项目：2016年广东省清远市社会发展领域自筹经费科技计划项目(编号：2016B136)