中老年人QTc间期与微量白蛋白尿的相关性研究  

Association of heart rate-corrected QT interval with microalbuminuria in middle aged and elderly community-based population

作　　者：陈晓鸥 邓婵娟 方云芬 唐志军 汤明明 谭利民 朱雯 代华杰 禤立平 王天歌[2] 毕宇芳[2] 王卫庆[2] 徐敏[2] 张寅飞 CHEN Xiaoou;DENG Chanjuan;FANG Yunfen;TANG Zhijun;TANG Mingming;TAN Limin;ZHU Wen;DAI Huajie;XUAN Liping;WANG Tiange;BI Yufang;WANG Weiqing;XU Min;ZHANG Yinfei(Department of Endocrine,Jiading District Central Hospital,Shanghai University of Medicine & Health Sciences,Shanghai 201800,China;Department of Endocrine and Metabolic Diseases,National Clinical Research Center for Metabolic Diseases,Shanghai Institute of Endocrine and Metabolic Diseases,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Jiading District Health and Family Planning Commission,Shanghai 201821,China)

机构地区：[1]上海健康医学院附属嘉定区中心医院内分泌科,上海201800 [2]上海交通大学医学院附属瑞金医院内分泌代谢病科国家代谢性疾病临床医学研究中心上海市内分泌代谢病研究所,上海200025 [3]上海市嘉定区卫生健康委员会,上海201821

出　　处：《内科理论与实践》2019年第3期161-166,共6页Journal of Internal Medicine Concepts & Practice

基　　金：上海市级医院适宜技术联合开发推广应用项目(项目编号:SHDC12016202)

摘　　要：目的:研究中老年人QTc间期与微量白蛋白尿的相关性。方法:选取上海市嘉定区9 315名40岁以上的居民作为研究对象,对其进行标准化问卷调查、体格检查、生化检测。采用静息心电图仪测量QT间期,Bazett公式计算QTc间期。采用速率散射比浊法和碱性苦味酸法分别测定尿白蛋白和尿肌酐,以尿白蛋白(mg/dL)/尿肌酐(g/dL)比值(urinaryalbumin-to-creatinine ratio,UACR)表示尿白蛋白排泄率,微量白蛋白尿诊断标准为30 mg/g≤UACR<300 mg/g。运用Logistic回归模型分析QTc间期与微量白蛋白尿之间的相关性。结果:在9 315名研究对象中,QTc间期延长者共1 407例(15.1%),微量白蛋白尿患者共567例(6.1%)。校正性别、年龄、体质量指数(body mass index,BMI)、吸烟、饮酒、高血压病史、高血压用药史、糖尿病病史、高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol,LDL-C)、三酰甘油(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)等混杂因素后,与QTc间期正常组相比,QTc间期延长者发生微量白蛋白尿的风险增加了37%[优势比(odds ratio,OR)=1.37,95%可信区间(confidence interval,CI):1.11~1.71,P=0.004]。结论:在中老年人中,QTc间期延长者占15.1%,微量白蛋白尿患病率为6.1%。QTc间期延长与微量白蛋白尿患病风险呈显著正相关,QTc间期延长是发生微量白蛋白尿的独立危险因素,识别QTc间期延长有助于微量白蛋白尿的早期发现。Objective:To investigate the relationship between the heart rate-corrected QT interval(QTc interval)and microalbuminuria.Methods:A total of 9 315 adult residents with age over 40 years from Shanghai Jiading district were enrolled in the study.Standard questionnaire,anthropometric measurements and biochemical evaluation were conducted and the QTc interval was calculated with Bazett’s formula.Urinary albumin and creatinine concentrations were determined with alkaline nitroxanthic acid based methods and nephelometry.Urinary albumin-to-creatinine ratio(UACR,mg/g)was calculated and the microalbuminuria was defined with UACR ranging between 30 and 300 mg/g.The association between QTc interval with microalbuminuria was analyzed with adjustment of multiple confounding factors.Results:Among the 1 407 subjects(15.1%)with prolonged QTc intervals,567 cases(6.1%)presented with microalbuminuria.A fully adjusted Logistic regression analysis revealed that compared with subjects with normal QTc interval,individuals with prolonged QTc interval had 37%higher risk of microalbuminuria[odds ratio(OR)=1.37,95%confidence interval(CI):1.11-1.71,P=0.004].Conclusions:In middle aged and elderly community-based population in Shanghai,the prevalence of microalbuminuria is 6.1%.The QTc interval is positively associated with microalbuminuria,and 15.1%of individuals with microalbuminuria are complicated with prolonged QTc intervals.Identification of the prolongation in QTc interval will facilitate early diagnose microalbuminuria.

关 键 词：QTC间期 微量白蛋白尿 心电图 

分 类 号：R696.2[医药卫生—泌尿科学] R540.41[医药卫生—外科学]