QT离散度对川崎病患儿发生冠状动脉损伤及其预后的预测价值  

Predictive value of QT dispersion for coronary artery injury and its prognosis in children with Kawasaki disease

作　　者：孙佳莹 付茜 辛雨[1] 张嵚垚 马淑梅[2] SUN Jiaying;FU Xi;XIN Yu;ZHANG Qinyao;MA Shumei(Department of Cardiac Function,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Cardiology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院心功能科,沈阳110004 [2]中国医科大学附属盛京医院心血管内科,沈阳110004

出　　处：《中国医科大学学报》2023年第3期193-198,共6页Journal of China Medical University

基　　金：国家自然科学基金(81901418)。

摘　　要：目的 探讨心电图QT离散度(QTd)对川崎病患儿冠状动脉损伤和预后的预测价值。方法 回顾性分析2018年1月至2021年7月中国医科大学附属盛京医院收治的1 743例川崎病患儿的临床资料。根据心电图QTd预测冠状动脉损伤和主要不良心脏事件的最佳截断值分别将患儿分为2组。分析QTd对川崎病患儿发生冠状动脉损伤和远期预后的影响。结果 QTd预测川崎病患儿冠状动脉损伤的受试者操作特征(ROC)曲线结果显示,曲线下面积(AUC)为0.940 (95%CI:0.893~0.986,P <0.001),QTd最佳截断值为38.5 ms,敏感度为88.64%,特异度为77.12%。QTd预测主要不良心脏事件的最佳截断值为39.5 ms (AUC=0.867,95%CI:0.792~0.934,P <0.001),灵敏度为78.57%,特异度83.71%。logistic多因素回归分析结果显示,QTd≥38.5 ms是冠状动脉损伤的独立预测因子。Kaplan-Meier生存分析发现QTd≥39.5组患者心律失常、川崎病复发发生率高于QTd<39.5组。Cox回归分析也证实QTd≥39.5 ms可以独立预测主要不良心脏事件的发生。结论 QTd对川崎病患儿是否发生冠状动脉损伤具有一定预测价值。对于QTd≥38.5 ms患儿应警惕冠状动脉损伤的发生;对于QTd≥39.5 ms患儿应警惕主要不良心脏事件的发生。Objective To investigate the predictive value of electrocardiographic QT dispersion(QTd)for coronary artery injury and prognosis in children with Kawasaki disease.Methods The clinical data of 1743 children with Kawasaki disease who were admitted to Shengjing Hospital of China Medical University from January 2018 to July 2021 were retrospectively analyzed.Children were divided into two groups according to the best cut-off value of QTd for predicting coronary artery injury and major adverse cardiac events.The effect of QTd on the occurrence of coronary artery injury and long-term prognosis in children with Kawasaki disease was analyzed.Results The results of the receiver operating characteristic(ROC)curve for QTd predicting coronary artery injury in children with Kawasaki disease showed an area under the curve(AUC)of 0.940(95%CI:0.893–0.986,P<0.001),QTd best cut-off value of 38.5 ms,a sensitivity of 88.64%and a specificity of 77.12%.Children were divided into a QTd<38.5 group(n=1174)and a QTd≥38.5 group(n=569).The best cut-off value for QTd to predict major adverse cardiac events was 39.5 ms(AUC=0.867,95%CI:0.792–0.934,P<0.001),with a sensitivity of 78.57%and a specificity of 83.71%.Children were divided into a QTd<39.5 group(n=1211)and a QTd≥39.5 group(n=532).Logistic multi-factor regression results showed that QTd≥38.5 ms was an independent predictor of coronary artery injury.Kaplan-Meier survival analysis showed that patients in the QTd≥39.5 group had a higher incidence of arrhythmias and recurrence of Kawasaki disease than those in the QTd<39.5 group.The Cox regression analysis also confirmed that QTd≥39.5 ms independently predicted the occurrence of major adverse cardiac events.Conclusion QTd has a predictive value for the occurrence of coronary artery injury in children with Kawasaki disease.In children with QTd≥38.5 ms,healthcare providers should be alerted to the occurrence of coronary artery injury;children with QTd≥39.5 ms should also be monitored closely for major adverse cardiac events

关 键 词：QT离散度 川崎病 冠状动脉损伤 预后 

分 类 号：R541[医药卫生—心血管疾病]