James Andrew F, Choisy Stéphanie C M, Hancox Jules C
Department of Physiology & Cardiovascular Research Laboratories, School of Medical Sciences, University of Bristol, Bristol, UK.
Prog Biophys Mol Biol. 2007 Jul;94(3):265-319. doi: 10.1016/j.pbiomolbio.2005.05.010. Epub 2005 Jun 13.
A number of gender differences exist in the human electrocardiogram (ECG): the P-wave and P-R intervals are slightly longer in men than in women, whilst women have higher resting heart rates than do men, but a longer rate-corrected QT (QT(C)) interval. Women with the LQT1 and LQT2 variants of congenital long-QT syndrome (LQTS) are at greater risk of adverse cardiac events. Similarly, many drugs associated with acquired LQTS have a greater risk of inducing torsades de pointes (TdP) arrhythmia in women than in men. There are also male:female differences in Brugada syndrome, early repolarisation syndrome and sudden cardiac death. The differences in the ECG between men and women, and in particular those relating to the QT interval, have been explored experimentally and provide evidence of differences in the processes underlying ventricular repolarization. The data available from rabbit, canine, rat, mouse and guinea pig models are reviewed and highlight involvement of male:female differences in Ca and K currents, although the possible involvement of rapid and persistent Na current and Na-Ca exchange currents cannot yet be excluded. The mechanisms underlying observed differences remain to be elucidated fully, but are likely to involve the influence of gonadal steroids. With respect to the QT interval and risk of TdP, a range of evidence implicates a protective role of testosterone in male hearts, possibly by both genomic and non-genomic pathways. Evidence regarding oestrogen and progesterone is less unequivocal, although the interplay between these two hormones may influence both repolarization and pro-arrhythmic risk.
人类心电图（ECG）存在一些性别差异：男性的P波和P-R间期略长于女性，而女性静息心率高于男性，但校正心率后的QT（QT(C)）间期更长。患有先天性长QT综合征（LQTS）的LQT1和LQT2变异型女性发生不良心脏事件的风险更高。同样，许多与获得性LQTS相关的药物在女性中比在男性中诱发尖端扭转型室速（TdP）心律失常的风险更大。在Brugada综合征、早期复极综合征和心源性猝死方面也存在男女差异。男女之间心电图的差异，尤其是与QT间期相关的差异，已通过实验进行了探索，并为心室复极过程中的差异提供了证据。对来自兔、犬、大鼠、小鼠和豚鼠模型的现有数据进行了综述，突出了男女在钙电流和钾电流方面的差异，尽管快速和持续性钠电流以及钠钙交换电流的可能参与尚未排除。观察到的差异背后的机制仍有待充分阐明，但可能涉及性腺类固醇的影响。关于QT间期和TdP风险，一系列证据表明睾酮对男性心脏具有保护作用，可能通过基因组和非基因组途径。关于雌激素和孕酮的证据则不太明确，尽管这两种激素之间的相互作用可能会影响复极和促心律失常风险。
