肝硬化患者心电图Q-Tc间期延长的临床意义  

Study of Q-Tc interval prolongation in liver cirrhosis

作　　者：郑盛 刘海 王玉波 

机构地区：[1]云南省第三人民医院消化内科,昆明市650011

出　　处：《肝脏》2009年第2期111-112,115,共3页Chinese Hepatology

摘　　要：目的探讨肝硬化患者Q-Tc间期变化及相关影响因素。方法检测125例肝硬化患者与50例非肝硬化患者心电图Q-Tc、凝血酶原时间(PT)、血清白蛋白(Alb)、血清总胆红素(TBil)、血清钾、血清钙、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)和碱性磷酸酶(ALP)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回归分析探讨Q-Tc与各项相关指标的关系。结果肝硬化组Q-Tc为(440±15)ms,非肝硬化组为(405±13)ms,两组比较P<0.001;以Q-Tc≥440ms为异常,肝硬化组异常率为37.90%(47/125),非肝硬化组为12.00%(6/50),两组比较P<0.001。肝硬化组中ChildC级的Q-Tc异常率为72.50%(25/34),B级为41.50%(19/45),A级为28.37%(13/46);A级与C级比较P<0.01。单因素直线相关回归分析结果显示,Q-Tc与Child积分呈正相关,相关系数r=0.31(P<0.01);与腹水程度呈正相关,相关系数r=0.24(P<0.05);与血清总胆红素(TBil)呈正相关,相关系数r=0.23(P<0.05)。结论肝硬化存在Q-Tc异常延长,病因是多因素性的,随肝硬化病情加重,Q-Tc异常率升高。Q-Tc延长是引起室性心律失常的常见诱因,可能也是肝硬化患者出现猝死的原因之一。Objective To investigate the impact factor on the aleration of Q-Tc interval in liver cirrhosis. Methods One hundred and twenty-five cases of liver cirrhosis and 50 control subjects were studied. Rate-corrected QTc, Child- Pugh scores, electrolytes and liver enzymes were assessed by linear regression analysis. Variables were correlated with Q- Tc by multiple regression analysis. Results Q-Tc was longer in patients with cirrhosis than that in controls[（440± 15） ms vs （405±13）ms, P〈0. 001 and prolonged in 47 patients（37. 90%） and in 6 controls（12. 00%, P〈0. 001）. In cirrhotic group, Q-Tc was prolonged in 25 patients（72.50%） in Child Pugh C, 19（41.50%） in Child-Pugh B and 13 （28.37%） in Child-Pugh A subgroup. Linear regression analysis showed Q-Tc was correlated with Child-Pugh scores and, severity of aseites and total bilirubin（TBil） （r = 0. 31,P〈0. 01;r = 0. 24, P〈0. 05;r = 0. 23,P〈0. 05, respectively）. Conclusion Q-Tc interval is frequently prolonged in patients with cirrhosis and worsened in parallel with severity of the disease. In cirrhotic patients, Q-Tc interval prolongation is one of the causes of sudden death due to provoke ventricular arrhythmia.

关 键 词：肝硬化 心电图 Q-TC间期 

分 类 号：R575.2[医药卫生—消化系统] R444[医药卫生—内科学]