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肝硬化患者QTc间期延长的患病率、危险因素及住院结局

Prevalence, Risk Factors and In-hospital Outcomes of QTc Interval Prolongation in Liver Cirrhosis.

作者信息

Zhao Jiancheng, Qi Xingshun, Hou Feifei, Ning Zheng, Zhang Xintong, Deng Han, Peng Ying, Li Jing, Wang Xiaoxi, Li Hongyu, Guo Xiaozhong

机构信息

Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China; Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, China.

Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning, China.

出版信息

Am J Med Sci. 2016 Sep;352(3):285-95. doi: 10.1016/j.amjms.2016.06.012. Epub 2016 Jun 28.

Abstract

BACKGROUND

QTc interval prolongation is an electrocardiographic abnormality in liver cirrhosis. The objective of this study was to evaluate the prevalence, risk factors and in-hospital outcomes of QTc interval prolongation in Chinese patients with liver cirrhosis.

METHODS

This was a retrospective analysis of a total of 1,268 patients with liver cirrhosis who were consecutively admitted to our hospital between January 2011 and June 2014. QTc interval data were collected from the medical records. QTc interval prolongation was defined as QTc interval > 440 milliseconds.

RESULTS

The prevalence of QTc interval prolongation was 38.2% (485 of 1268). In the entire cohort, the risk factors for QTc interval prolongation included an older age, a higher proportion of alcohol abuse and ascites, higher bilirubin, blood urea nitrogen, creatinine, prothrombin time, international normalized ratio, Child-Pugh score and model for end-stage liver diseases score, and lower red blood cell (RBC), hemoglobin (Hb), albumin (ALB), alanine aminotransferase and calcium. The in-hospital mortality was not significantly different between patients with and without QTc interval prolongation (2.1% versus 1.3%, P = 0.276). In the subgroup analyses of patients with hepatitis B virus or alcohol alone-related liver cirrhosis, the risk factors included higher bilirubin, creatinine, prothrombin time, international normalized ratio, Child-Pugh score and model for end-stage liver diseases score, and lower RBC, Hb and ALB. In the subgroups analyses of patients with acute upper gastrointestinal bleeding or ascites, the risk factors included lower RBC, Hb and ALB.

CONCLUSIONS

QTc interval prolongation was frequent in liver cirrhosis. Although QTc interval prolongation was positively associated with alcohol-related liver cirrhosis and more severe liver dysfunction, it did not significantly influence the in-hospital mortality.

摘要

背景

QTc间期延长是肝硬化患者的一种心电图异常表现。本研究旨在评估中国肝硬化患者QTc间期延长的患病率、危险因素及住院结局。

方法

这是一项对2011年1月至2014年6月期间连续入住我院的1268例肝硬化患者的回顾性分析。从病历中收集QTc间期数据。QTc间期延长定义为QTc间期>440毫秒。

结果

QTc间期延长的患病率为38.2%(1268例中的485例)。在整个队列中,QTc间期延长的危险因素包括年龄较大、酒精滥用和腹水比例较高、胆红素、血尿素氮、肌酐、凝血酶原时间、国际标准化比值、Child-Pugh评分和终末期肝病模型评分较高,以及红细胞(RBC)、血红蛋白(Hb)、白蛋白(ALB)、丙氨酸氨基转移酶和钙较低。QTc间期延长患者和未延长患者的住院死亡率无显著差异(2.1%对1.3%,P = 0.276)。在乙型肝炎病毒或单纯酒精性肝硬化患者的亚组分析中,危险因素包括胆红素、肌酐、凝血酶原时间、国际标准化比值、Child-Pugh评分和终末期肝病模型评分较高,以及RBC、Hb和ALB较低。在急性上消化道出血或腹水患者的亚组分析中,危险因素包括RBC、Hb和ALB较低。

结论

肝硬化患者中QTc间期延长较为常见。虽然QTc间期延长与酒精性肝硬化及更严重的肝功能障碍呈正相关,但对住院死亡率无显著影响。

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