肝硬化患者肝移植前后校正 QT 间期和 QT 离散度。

Corrected QT interval and QT dispersion in cirrhotic patients before and after liver transplantation.

机构信息

Department of Cardiology, Cardiovascular Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.

出版信息

Arch Iran Med. 2012 Jun;15(6):375-7.

PMID:22642249

Abstract

BACKGROUND

Liver cirrhosis is associated with different types of electrophysiological changes, including QT prolongation, which may adversely affect long-term prognosis of these patients. The aim of this study is to evaluate the effect of orthotopic liver transplantation (LT) on corrected QT (QTc) interval and QT dispersion (QTd) in cirrhotic patients of various etiologies.

METHODS

We enrolled 249 patients with end-stage liver disease between 2004 and 2009 at Shiraz Transplant Research Center, Shiraz, Iran. The QTc interval and QTd were measured by 12 lead ECGs for baseline and at 3 months after LT. Mean QTc interval and mean QTd were calculated. A QTc interval above 440 ms was considered abnormal.

RESULTS

Within 3 months following surgery, 6 patients died. There were 105 patients (43.2%) with prolonged QTc before transplantation; in 91 (86.6%) patients, the mean QTc normalized after transplantation (baseline: 490.9 ± 45.74 ms; post-transplantation: 385 ± 48.74 ms; P < 0.0001). Fourteen patients (13.3%) had evidence of some shortening of the QTc interval although the QTc remained above the upper limit of normal. Prolongation of the QTc interval in cirrhotic patients was independent of the etiology of cirrhosis. A normal QTc was seen in 138 patients (56.7%) before transplantation, of which 4 (2.9%) developed prolonged QTc after transplantation. The mean QTd decreased significantly after transplantation (baseline: 30 ± 20 ms; post-transplantation: 30 ± 10 ms; P < 0.0001).

CONCLUSION

Many cirrhotic patients have prolonged QTc intervals before LT regardless of disease etiology. In the majority of patients this value returns to normal after LT, suggesting that liver cirrhosis has independent unfavorable, but reversible electrophysiological effects.

摘要

背景

肝硬化与包括 QT 间期延长在内的不同类型电生理变化相关，这可能对这些患者的长期预后产生不利影响。本研究旨在评估原位肝移植（LT）对不同病因肝硬化患者校正 QT（QTc）间期和 QT 离散度（QTd）的影响。

方法

我们纳入了 2004 年至 2009 年在伊朗设拉子移植研究中心就诊的 249 例终末期肝病患者。在 LT 前和术后 3 个月通过 12 导联心电图测量 QTc 间期和 QTd。计算平均 QTc 间期和平均 QTd。QTc 间期超过 440 ms 被认为异常。

结果

术后 3 个月内，有 6 例患者死亡。移植前有 105 例（43.2%）患者存在 QTc 延长；91 例（86.6%）患者术后平均 QTc 恢复正常（基线：490.9 ± 45.74 ms；移植后：385 ± 48.74 ms；P < 0.0001）。虽然 QTc 仍高于正常值上限，但 14 例（13.3%）患者的 QTc 间隔略有缩短。肝硬化患者的 QTc 延长与肝硬化的病因无关。移植前 138 例（56.7%）患者 QTc 正常，其中 4 例（2.9%）移植后出现 QTc 延长。移植后 QTd 显著降低（基线：30 ± 20 ms；移植后：30 ± 10 ms；P < 0.0001）。