Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Food and Health Science Research Unit, Graduate School of Agricultural Science, Tohoku University, Sendai, Japan.
J Diabetes Investig. 2018 Jul;9(4):946-951. doi: 10.1111/jdi.12772. Epub 2017 Dec 13.
AIMS/INTRODUCTION: A prolonged QT interval plays a causal role in life-threatening arrhythmia, and becomes a risk factor for sudden cardiac death. Here, we assessed the association between microvascular complications and the QT interval in patients with type 2 diabetes.
Patients with type 2 diabetes (n = 219) admitted to Nippon Medical School Hospital (Tokyo, Japan) for glycemic control were enrolled. QT interval was measured manually in lead II on the electrocardiogram, and corrected for heart rate using Bazett's formula (QTc). Diabetic neuropathy, retinopathy and nephropathy were assessed by neuropathic symptoms or Achilles tendon reflex, ophthalmoscopy and urinary albumin excretion, respectively.
In univariate analyses, female sex (P = 0.025), duration of type 2 diabetes (P = 0.041), body mass index (P = 0.0008), systolic blood pressure (P = 0.0011) and receiving insulin therapy (P < 0.0001) were positively associated with QTc. Patients with each of the three microvascular complications had longer QTc than those without: neuropathy (P = 0.0005), retinopathy (P = 0.0019) and nephropathy (P = 0.0001). As retinopathy or nephropathy progressed, QTc became longer (P < 0.001 and P < 0.001 for trend in retinopathy and nephropathy, respectively). Furthermore, QTc was prolonged with the multiplicity of the microvascular complications (P < 0.001 for trend). Multiple regression analyses showed that neuropathy, nephropathy and the multiplicity of the microvascular complications were independently associated with QTc.
Patients with type 2 diabetes with severe microvascular complications might be at high risk for life-threatening arrhythmia associated with QT interval prolongation.
目的/引言：QT 间期延长在危及生命的心律失常中起因果作用，并成为心源性猝死的危险因素。在这里，我们评估了 2 型糖尿病患者微血管并发症与 QT 间期的关系。
共纳入 219 例因血糖控制而入住日本顺天堂大学医院（东京，日本）的 2 型糖尿病患者。心电图 II 导联上手动测量 QT 间期，并使用 Bazett 公式（QTc）校正心率。神经病、视网膜病变和肾病分别通过神经病症状或跟腱反射、眼底检查和尿白蛋白排泄评估。
在单变量分析中，女性（P = 0.025）、2 型糖尿病病程（P = 0.041）、体重指数（P = 0.0008）、收缩压（P = 0.0011）和接受胰岛素治疗（P < 0.0001）与 QTc 呈正相关。有三种微血管并发症的患者的 QTc 均长于无并发症的患者：神经病（P = 0.0005）、视网膜病变（P = 0.0019）和肾病（P = 0.0001）。随着视网膜病变或肾病的进展，QTc 变得更长（视网膜病变和肾病的趋势分别为 P < 0.001 和 P < 0.001）。此外，随着微血管并发症的多发性，QTc 延长（趋势 P < 0.001）。多变量回归分析显示，神经病、肾病和微血管并发症的多发性与 QTc 独立相关。
有严重微血管并发症的 2 型糖尿病患者可能有发生与 QT 间期延长相关的危及生命的心律失常的高风险。
