心率校正QT间期是2型糖尿病患者蛋白尿进展的一种新型风险标志物。

Heart rate-corrected QT interval is a novel risk marker for the progression of albuminuria in people with Type 2 diabetes.

作者信息

Hashimoto Y, Tanaka M, Senmaru T, Okada H, Hamaguchi M, Asano M, Yamazaki M, Oda Y, Hasegawa G, Nakamura N, Fukui M

机构信息

Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.

Division of Metabolism, Nephrology and Rheumatology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.

出版信息

Diabet Med. 2015 Sep;32(9):1221-6. doi: 10.1111/dme.12728. Epub 2015 Feb 26.

DOI:10.1111/dme.12728

PMID:25683576

Abstract

AIMS

A close association between heart rate-corrected QT interval (QTc) and albuminuria in people with Type 2 diabetes has been reported in cross sectional studies. The aim of this study was to evaluate the relationship between QTc and change in urine albumin excretion (UAE) or progression of albuminuria in people with Type 2 diabetes.

METHODS

We measured QTc in 251 consecutive people at baseline. We performed a 5-year follow-up cohort study to assess the relationship between QTc and change in UAE, defined as an increase of UAE/follow-up duration (year), or progression of albuminuria, defined as an increase in the category of diabetic nephropathy.

RESULTS

During follow-up, 23 of 151 people with normoalbuminuria and 13 of 73 people with microalbuminuria at baseline had progression of albuminuria. Multiple regression analysis demonstrated that QTc was independently associated with change in UAE (β = 0.176, P = 0.0104). Logistic regression analyses showed that QTc was a risk marker for progression of albuminuria [odds ratio per 0.01-s increase in QTc 1.35, 95% confidence interval (CI) 1.11-1.66, P = 0.0024] after adjusting for confounders. According to the receiver operator characteristic (ROC) analysis, the optimal cut-off point of QTc for progression of albuminuria was 0.418 s [area under the ROC curve 0.75 (95% CI 0.66-0.82), sensitivity = 0.86, specificity = 0.56, P < 0.0001].

CONCLUSIONS

Heart rate-corrected QT interval could be a novel risk marker for progression of albuminuria in people with Type 2 diabetes.

摘要

目的

横断面研究报道2型糖尿病患者心率校正QT间期（QTc）与蛋白尿之间存在密切关联。本研究旨在评估2型糖尿病患者QTc与尿白蛋白排泄量（UAE）变化或蛋白尿进展之间的关系。

方法

我们在基线时测量了251例连续患者的QTc。我们进行了一项为期5年的队列研究，以评估QTc与UAE变化（定义为UAE/随访时间（年）的增加）或蛋白尿进展（定义为糖尿病肾病类别增加）之间的关系。

结果

随访期间，基线时151例正常白蛋白尿患者中有23例、73例微量白蛋白尿患者中有13例出现蛋白尿进展。多元回归分析表明，QTc与UAE变化独立相关（β = 0.176，P = 0.0104）。逻辑回归分析显示，校正混杂因素后，QTc是蛋白尿进展的风险标志物[QTc每增加0.01秒的比值比为1.35，95%置信区间（CI）为1.11 - 1.66，P = 0.0024]。根据受试者工作特征（ROC）分析，蛋白尿进展的QTc最佳截断点为0.418秒[ROC曲线下面积为0.75（95%CI为0.66 - 0.82），敏感性 = 0.86，特异性 = 0.56，P < 0.0001]。