Tsiompanidis Elias, Siakavellas Spyros I, Tentolouris Anastasios, Eleftheriadou Ioanna, Chorepsima Stamatia, Manolakis Anastasios, Oikonomou Konstantinos, Tentolouris Nikolaos
First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 11527, Greece.
World J Gastrointest Pathophysiol. 2018 Feb 15;9(1):28-36. doi: 10.4291/wjgp.v9.i1.28.
To examine the impact of liver cirrhosis on QT interval and cardiac autonomic neuropathy (CAN).
A total of 51 patients with cirrhosis and 51 controls were examined. Standard 12-lead electrocardiogram recordings were obtained and QT as well as corrected QT interval (QTc) and their dispersions (dQT, dQTc) were measured and calculated using a computer-based program. The diagnosis of CAN was based upon the battery of the tests proposed by Ewing and Clarke and the consensus statements of the American Diabetes Association. CAN was diagnosed when two out of the four classical Ewing tests were abnormal.
QT, QTc and their dispersions were significantly longer ( < 0.01) in patients with cirrhosis than in controls. No significant differences in QT interval were found among the subgroups according to the etiology of cirrhosis. Multivariate regression analysis after controlling for age, gender and duration of cirrhosis demonstrated significant association between QT and presence of diabetes mellitus [standardized regression coefficient (beta) = 0.45, = 0.02] and treatment with diuretics (beta = 0.55, = 0.03), but not with the Child-Pugh score ( = 0.54). Prevalence of CAN was common (54.9%) among patients with cirrhosis and its severity was associated with the Child-Pugh score ( = 0.33, = 0.02). Moreover, patients with decompensated cirrhosis had more severe CAN that those with compensated cirrhosis ( = 0.03). No significant association was found between severity of CAN and QT interval duration.
Patients with cirrhosis have QT prolongation. Treatment with diuretics is associated with longer QT. CAN is common in patients with cirrhosis and its severity is associated with severity of the disease.
探讨肝硬化对QT间期及心脏自主神经病变（CAN）的影响。
共检查了51例肝硬化患者和51例对照者。记录标准12导联心电图，使用计算机程序测量并计算QT间期、校正QT间期（QTc）及其离散度（dQT、dQTc）。CAN的诊断基于尤因和克拉克提出的一系列测试以及美国糖尿病协会的共识声明。当四项经典尤因测试中有两项异常时，诊断为CAN。
肝硬化患者的QT、QTc及其离散度显著长于对照组（<0.01）。根据肝硬化病因分组，各亚组之间QT间期无显著差异。在控制年龄、性别和肝硬化病程后进行多变量回归分析，结果显示QT与糖尿病的存在[标准化回归系数（β）=0.45，P=0.02]以及利尿剂治疗（β=0.55，P=0.03）显著相关，但与Child-Pugh评分无关（P=0.54）。肝硬化患者中CAN的患病率较高（54.9%），其严重程度与Child-Pugh评分相关（P=0.33，P=0.02）。此外，失代偿期肝硬化患者的CAN比代偿期肝硬化患者更严重（P=0.03）。未发现CAN严重程度与QT间期持续时间之间存在显著关联。
肝硬化患者存在QT间期延长。利尿剂治疗与较长的QT间期相关。CAN在肝硬化患者中很常见，其严重程度与疾病严重程度相关。
