急性病毒性肝炎患者心电图异常相关因素及其对预后的预测价值  

Influencing Factors of Electrocardiogram Abnormality in Patients with Acute Viral Hepatitis and Its Prognostic Value

作　　者：贺世超 王瑜[2] 朱斌[3] HE Shichao;WANG Yu;ZHU Bin(Department of Cardiology,Jianyang People's Hospital,Jianyang,Sichuan 641400,China;Center for Comprehensive Geriatrics,the Fourth People's Hospital of Chengdu City,Chengdu 610036,China;Department of Gastrointestinal Surgery,Ba'nan Hospital Affiliated to Chongqing Medical University,Chongqing 401302,China)

机构地区：[1]简阳市人民医院心内科,四川简阳641400 [2]成都市第四人民医院老年医学综合治疗中心,成都610036 [3]重庆医科大学附属巴南医院胃肠外科,重庆401302

出　　处：《临床误诊误治》2024年第4期24-28,41,共6页Clinical Misdiagnosis & Mistherapy

基　　金：四川省医学会医学科研青年创新课题(Q21063)。

摘　　要：目的探讨急性病毒性肝炎患者心电图异常相关因素及其对预后的预测价值。方法选取2020年2月—2023年2月收治的伴心电图异常急性病毒性肝炎78例为异常组,无心电图异常急性病毒性肝炎120例为无异常组,收集2组临床资料并分析心电图异常相关因素。随访6个月,将心电图异常78例分为预后良好组[多器官功能障碍综合征(MODS)评分≤12分]、预后不良组(MODS评分>12分),分析心电图异常相关因素对急性病毒性肝炎患者预后影响及预测价值。结果心电图异常78例心电图表现为T波改变(42.31%,33/78)、窦性心动过缓(34.62%,27/78)、窦性心动过缓伴窦性心律不齐(24.36%,19/78)等。Logistic回归分析显示,疾病类型、总胆红素(TBIL)、脑钠肽(BNP)、左心室Tei指数及伴肝硬化、伴门静脉高压是急性病毒性肝炎患者心电图异常的影响因素(P<0.05)。预后良好组、预后不良组疾病类型、TBIL、BNP、左心室Tei指数及伴肝硬化、伴门静脉高压患者所占比例比较差异有统计学意义(P<0.05)。受试者工作特征曲线显示疾病类型、TBIL、BNP、左心室Tei指数、伴肝硬化、伴门静脉高压联合预测急性病毒性肝炎患者预后的曲线下面积为0.943,大于各指标单独预测(P<0.05)。结论急性病毒性肝炎患者心电图异常与疾病类型、TBIL、BNP、左心室Tei指数、伴肝硬化、伴门静脉高压相关,且相关因素对患者预后有一定预测价值。Objective To explore the factors related to electrocardiogram(ECG)abnormality in patients with acute viral hepatitis(AVH)and its prognostic value.Methods Seventy-eight patients with AVH and abnormal ECG treated from February 2020 to February 2023 were selected as the abnormal group,and another 120 patients with AVH but without abnormal ECG were selected as the abnormal group.Clinical data of the two groups were collected and the related factors of abnormal ECG were analyzed.The patients were followed up for 6 months,and 78 patients with abnormal ECG were divided into good prognosis group[the multiple organ dysfunction syndrome(MODS)score≤12 points]and poor prognosis group(MODS score>12 points).The impact of ECG abnormalityrelated factors on the prognosis of patients with AVH as well as its predictive value was analyzed.Results The abnormal ECG manifestations of 78 patients with abnormal ECG were mainly T wave changes(42.31%,33/78),sinus bradycardia(34.62%,27/78),and sinus bradycardia with sinus arrhythmia(24.36%,19/78).Logistic regression analysis showed that disease type,total bilirubin(TBIL),brain natriuretic peptide(BNP),left ventricular Tei index,combined hepatocirrhosis and portal hypertension were the influencing factors of abnormal ECG in patients with AVH(P<0.05).There were significant differences in disease type,TBIL,BNP,left ventricular Tei index and the proportion of patients with hepatocirrhosis and portal hypertension between good prognosis group and poor prognosis group(P<0.05).Receiver operating characteristic curve showed that the area under the curve of disease type,TBIL,BNP,left ventricular Tei index,as well as combined cirrhosis and portal hypertension in predicting AVH,was 0.943,which was greater than that predicted by each index alone(P<0.05).Conclusion ECG abnormalities in patients with AVH are related to disease type,TBIL,BNP,left ventricular Tei index,hepatocirrhosis,and portal hypertension,and the related factors have certain prognostic value in patients with AVH.

关 键 词：肝炎 病毒性 人 心电描记术 多器官功能衰竭 预后 心动过缓 利钠肽 脑 左心室Tei指数 肝硬化 

分 类 号：R512.6[医药卫生—内科学]