透析患者的 QT 延长：一项关注营养不良的流行病学研究。

QT Prolongation in Dialysis Patients: An Epidemiological Study with a Focus on Malnutrition.

机构信息

Japan Association for Clinical Engineers, Tokyo, Japan,

Department of Hemodialysis, Koujukai Rehabilitation Hospital, Kita-Nagoya, Japan,

出版信息

Blood Purif. 2023;52(5):407-414. doi: 10.1159/000512961. Epub 2021 Jan 26.

DOI:10.1159/000512961

PMID:33498053

Abstract

BACKGROUND/AIMS: QT prolongation is a known risk factor for ventricular fibrillation and ventricular tachycardia. Therefore, more refined management is necessary to reduce sudden cardiac death secondary to such arrhythmias.

METHODS

Electrocardiographic findings were reviewed in 224 patients, and the associations of QT prolongation with various clinical parameters were examined, including the nutritional state. Correlations were also examined between QT prolongation and body composition measurements determined by multifrequency bioelectrical impedance analysis.

RESULTS

Prolongation of the corrected QT (QTc) interval over 0.44 s was seen in 140 patients (62.5%). QT prolongation was independent of age and dialysis therapy duration and was more frequent in diabetics (70.1%) than in nondiabetics (54.2%, p = 0.014) and more frequent in women (78.8%) than in men (53.5%, p < 0.001). Serum levels of albumin (p < 0.001) and Cr (p < 0.001) and the Geriatric Nutritional Risk Index (GNRI, p < 0.001) were negatively correlated with QTc interval; no significant correlation was noted with total protein, urea nitrogen, or uric acid. Negative correlations with QTc interval were found for BMI(p < 0.01), percent total body water (%TBW; p < 0.05), and percent intracellular water (%ICW; p < 0.01) but not with the percent extracellular water/TBW ratio or edema ratio. The longer the QTc interval, the lower the fat-free mass (FFM; p < 0.01) and muscle mass (MM; p < 0.01), but there was no significant correlation with percent fat.

CONCLUSION

These results suggest that QT prolongation is a common complication and is more frequent in women and diabetic patients. The decreases in serum albumin and Cr levels, GNRI, BMI, %TBW, %ICW, FFM, and MM together coincided with malnutrition and thus suggest a close relationship of QT prolongation with malnutrition. Management of QT prolongation may be achieved better in the future by understanding these biochemical and biophysical changes, particularly those regarding malnutrition.

摘要

背景/目的：QT 间期延长是导致室颤和室速的已知危险因素。因此，需要更精细的管理来降低此类心律失常导致的心脏性猝死。

方法

对 224 例患者的心电图结果进行了回顾性分析，并对 QT 间期延长与各种临床参数的相关性进行了研究，包括营养状况。还对 QT 间期延长与多频生物电阻抗分析确定的身体成分测量值之间的相关性进行了研究。

结果

140 例患者（62.5%）出现校正 QT（QTc）间期延长超过 0.44 s。QT 间期延长与年龄和透析治疗时间无关，在糖尿病患者中更为常见（70.1%），而非糖尿病患者中则较为少见（54.2%，p = 0.014），在女性中更为常见（78.8%），而在男性中则较少见（53.5%，p < 0.001）。血清白蛋白（p < 0.001）和 Cr（p < 0.001）水平以及老年营养风险指数（GNRI，p < 0.001）与 QTc 间期呈负相关；总蛋白、尿素氮或尿酸与 QTc 间期无显著相关性。QTc 间期与 BMI（p < 0.01）、总体水分百分比（%TBW；p < 0.05）和细胞内水分百分比（%ICW；p < 0.01）呈负相关，但与细胞外水分/TBW 比值或水肿比值无显著相关性。QTc 间期越长，无脂肪质量（FFM；p < 0.01）和肌肉质量（MM；p < 0.01）越低，但与脂肪百分比无显著相关性。

结论

这些结果表明，QT 间期延长是一种常见的并发症，在女性和糖尿病患者中更为常见。血清白蛋白和 Cr 水平、GNRI、BMI、%TBW、%ICW、FFM 和 MM 的降低与营养不良同时发生，提示 QT 间期延长与营养不良密切相关。通过了解这些生化和生物物理变化，特别是与营养不良有关的变化，未来可能会更好地管理 QT 间期延长。