原发性甲状旁腺功能亢进症患者心电图特征  

Electrocardiographic characteristics in patients with primary hyperparathyroidism

作　　者：倪熠[1] 王晓峰 荆译萱 周艳满 郑光卓[1] 何泱[2] 孙立昊[2] 陶蓓[2] 刘建民[2] 赵红燕[2] NI Yi;WANG Xiao-feng;JING Yi-xuan;ZHOU Yan-man;ZHENG Guang-zhuo;HE Yang;SUN Li-hao;TAO Bei;LIU Jian-min;ZHAO Hong-yan(Department of Cardiology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Endocrinology and Metabolic Diseases,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai Clinical Center for Endocrine and Metabolic Disease,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院心内科,上海200025 [2]上海交通大学医学院附属瑞金医院内分泌代谢科上海市内分泌代谢病临床医学中心,上海200025

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2018年第6期540-544,共5页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：上海市卫生和计划委员会课题(201540116)

摘　　要：目的分析原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者的心电图特征,探讨PHPT患者心电图异常与血钙水平的关系。方法收集上海交通大学医学院附属瑞金医院2015年1月至2017年12月诊治的PHPT患者,共134例作为观察组,同时选择年龄与性别匹配的同期健康体检者149例作为对照组,比较两组之间的心电图差异。根据血钙水平按三分位将观察组分为3个亚组,比较3组间心电图异常水平,并探讨血钙水平与心电图异常之间的关系。结果观察组心电图异常率为55. 2%,对照组心电图异常率为22. 1%,差异有统计学意义(P<0. 001)。异常心电图表现以ST-T改变和心律失常为主,少部分患者存在左室高电压。观察组ST-T改变(P<0. 001)及心律失常(P=0. 009)的比例明显高于对照组,但两组间比较左室高电压无统计学差异(P>0. 05)。观察组QTc间期较对照组明显缩短(P=0. 009),而QRS波时间较对照组显著延长(P<0. 001)。PHPT 3个亚组间QTc间期(P=0. 038)和QRS波时间(P=0. 025)存在显著差异。Pearson相关分析发现PHPT患者血钙水平与QTc间期呈明显负相关(r=-0. 263,P=0. 002),与QRS波时间呈明显正相关(r=0. 245,P=0. 004),且在校正年龄、性别、甲状旁腺素(parathyroid hormone,PTH)水平和钙通道阻滞剂(calcium channel blockers,CCB)服用情况后,这种相关关系仍然存在。结论 PHPT患者心电图异常率显著高于对照组,QTc间期缩短、QRS波时间延长与升高的血钙水平密切相关。Objective To analyze the electrocardiographic （ECG） characteristics in patients with primary hyperparathyroidism （PHPT） and to explore the relationship between ECG abnormality and serum calcium levels in relevant patients. Methods Totally 134 PHPT patients treated in our hospital from Jan 2015 to Dec 2017 were included as observation group. At the same time, 149 healthy subjects from regular physical examination were included as control group. The manifestations of ECG were compared between the two groups. Meanwhile, according to tertile levels of serum calcium, PHPT patients were further divided into 3 subgroups. The ECG abnormalities were compared among 3 subgroups and the relationship between ECG changes and serum calcium levels was also studied. Results The ECG abnormality rates in observation group were higher than those in control group （55.2% vs. 22.1%, P 〈0.001）. Abnormal ECG manifestations were mainly ST-T changes and arrhythmias, and a few patients had high left ventricular pressure. Observation group presented more frequent ST-T changes （ P 〈0.001）, arrhythmias （ P =0.009）, corrected QT interval shortening （ P =0.009）, and QRS duration widening （ P 〈0.001） in comparing with control group. However, the difference of high left ventricular pressure between 2 groups was not significant. In the observation group, the differences of corrected QT interval （ P =0.038） and QRS duration （ P =0.025） among the 3 subgroups were also significant. Pearson analysis revealed that serum calcium levels were negatively correlated with corrected QT interval （ r =-0.263, P =0.002）, and positively correlated with QRS duration （ r =0.245, P =0.004）. The relationships were still remained even after adjusting for sex, age, serum parathyroid hormone （PTH） levels, and usage of calcium channel blockers （CCB）. Conclusion PHPT patients had higher incidence of abnormal ECG, while the shortened corrected QT interval and the widened QRS duration were related to serum calcium lev

关 键 词：原发性甲状旁腺功能亢进症 心电图 高钙血症 

分 类 号：R582[医药卫生—内分泌]