Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER, Puducherry, India 605006, Email:
J R Coll Physicians Edinb. 2020 Dec;50(4):380-386. doi: 10.4997/JRCPE.2020.406.
The QT interval a marker of ventricular depolarization and repolarization is reported to be prolonged in some proportion of patients with systemic lupus erythematosus (SLE). We studied electrocardiographic (ECG) abnormalities, in particular QT interval and its relationship with anti-Ro antibodies, disease activity, and serum interleukin 1β (IL-1β), interleukin 6 (IL-6) in SLE.
A 12-lead resting ECG was performed on 140 adult SLE patients fulflling SLICC/ACR classification criteria. All patients received hydroxychloroquine and prednisolone. Corrected QT (QTc) °440 milliseconds (ms) was defined as prolonged QTc. QT dispersion (QTd) °60 ms was defined as increased QTd.
Eighty-four patients had some form of ECG abnormality. Prolongation of QTc and QTd was present in 24 (17.1%) and 50 (35.7%) respectively. Anti-Ro/SSA antibodies were present in 63 (45%). Prolongation of QTc in anti-Ro positive versus anti-Ro negative was 17.5% and 17% respectively, p=0.98. Prolongation of QTd in anti-Ro-positive versus anti-Ro-negative was 32% and 39% respectively, p=0.37. Prolonged QTc was observed in 15% patients with SLEDAI ˛4 compared to 17.5% patients with SLEDAI °5, p=0.78. The median serum concentrations of IL-1β and IL-6 were similar in the groups with and without prolonged QTc, with and without prolonged QTd. On binary logistic regression analyses neither clinical nor laboratory factors were predictors of prolonged QTc. However, having valvular regurgitation and hypercholesterolemia was associated with significantly reduced odds of having prolonged QTd, adjusted OR 0.33 (CI 0.14-0.83), p=0.018 and 0.19 (CI 0.05-0.80), p=0.023 respectively. Those with high LDL cholesterol and hypertriglyceridemia had a significantly higher odds of having a normal QTd with adjusted OR of 4.34 (1.31-14.46) p=0.017and 5.59 (1.62-19.38) p=0.007respectively.
Though 17% and 35% SLE patients have QTc and QTd prolongation, association with anti-Ro antibodies or disease activity was absent. A large proportion has other asymptomatic ECG abnormalities that may reflect subclinical cardiac involvement.
QT 间期是心室去极化和复极的标志物，据报道，在一些系统性红斑狼疮（SLE）患者中存在 QT 间期延长。我们研究了心电图（ECG）异常，特别是 QT 间期及其与抗 Ro 抗体、疾病活动和血清白细胞介素 1β（IL-1β）、白细胞介素 6（IL-6）的关系。
对 140 例符合 SLICC/ACR 分类标准的成年 SLE 患者进行 12 导联静息心电图检查。所有患者均接受羟氯喹和泼尼松龙治疗。校正 QT（QTc）>440 毫秒（ms）定义为 QTc 延长。QT 离散度（QTd）>60 ms 定义为 QTd 增加。
84 例患者存在某种形式的心电图异常。QTc 和 QTd 延长分别见于 24 例（17.1%）和 50 例（35.7%）。63 例患者存在抗 Ro/SSA 抗体。抗 Ro 阳性与抗 Ro 阴性患者的 QTc 延长分别为 17.5%和 17%，p=0.98。抗 Ro 阳性患者的 QTd 延长与抗 Ro 阴性患者分别为 32%和 39%，p=0.37。SLEDAI>4 的患者中有 15%存在 QTc 延长，而 SLEDAI=5 的患者中有 17.5%存在 QTc 延长，p=0.78。QTc 延长组与无 QTc 延长组的血清白细胞介素 1β和白细胞介素 6 中位数浓度相似，QTd 延长组与无 QTd 延长组相似。二元逻辑回归分析显示，无论是临床因素还是实验室因素都不是 QTc 延长的预测因素。然而，存在瓣膜反流和高胆固醇血症与 QTd 延长的可能性显著降低有关，调整后的比值比（OR）分别为 0.33（95%CI：0.14-0.83），p=0.018 和 0.19（95%CI：0.05-0.80），p=0.023。高 LDL 胆固醇和高甘油三酯血症患者的 QTd 正常的可能性显著增加，调整后的 OR 分别为 4.34（95%CI：1.31-14.46），p=0.017 和 5.59（95%CI：1.62-19.38），p=0.007。
尽管 17%和 35%的 SLE 患者存在 QTc 和 QTd 延长，但与抗 Ro 抗体或疾病活动无关。很大一部分患者存在其他无症状的心电图异常，可能反映出亚临床心脏受累。
