维持性血液透析患者乳酸脱氢酶与 QTc 间期延长的相关性：一项横断面研究。
Correlation between lactate dehydrogenase and QTc interval prolongation in maintenance hemodialysis patients: a cross-sectional study.
机构信息
Department of Nephrology, The Second Affiliated Hospital of Nantong University, Nantong, China.
出版信息
Ann Palliat Med. 2022 Nov;11(11):3444-3454. doi: 10.21037/apm-22-1053.
BACKGROUND
Corrected QT (QTc) interval prolongation is one of the common causes of sudden cardiac death in patients with maintenance hemodialysis (MHD) patients. However, there are few studies on QTc prolongation in MHD patients. The concentration of lactate dehydrogenase (LDH) in hemodialysis population increased, and LDH was associated with the mortality of MHD patients. This study aimed to investigate the relationship between QTc interval prolongation and LDH in MHD patients.
METHODS
This is a cross-sectional observational study. Patients who underwent MHD for more than 3 months in the Second Affiliated Hospital of Nantong University from November 2012 to November 2019 with complete data were selected as the research subjects. The patients were divided into the normal QTc interval group and the QTc interval prolongation group. The general data of patients and clinical laboratory indicators were collected retrospectively from the electronic medical record system. Pearson correlation analysis and binary logistic regression were used to analyze the correlation between LDH and QTc interval prolongation; the cut-off value of LDH predicting QTc interval prolongation was calculated by receiver operating characteristic (ROC) curve.
RESULTS
The LDH level in the prolonged QTc interval group was significantly higher than that in the normal group (301.96±110.91 vs. 215.39±67.65, t=-8.03, P<0.001). QTc interval and LDH (r=0.386) were positively correlated. Binary logistic regression analysis showed that LDH, serum potassium <4 mmol/L, serum phosphorus, and left ventricular end-diastolic diameter (LVDd) were independent related factors for QTc interval prolongation. The ROC curve results showed that LDH =220 U/L was the best cutoff point for predicting QTc interval prolongation in MHD patients, with a sensitivity of 81.45% and a specificity of 59.35%. Binary logistic regression analysis showed that the LDH >220 U/L group was 6.34 times more likely to have QTc interval prolongation than the LDH ≤220 U/L group (OR 6.34, 95% CI: 3.47-11.58, P<0.001).
CONCLUSIONS
LDH in MHD patients is closely related to QTc interval prolongation. Serum LDH, ionic calcium, serum phosphorus and potassium may predict QTc interval prolongation. Monitoring related indicators can remind clinicians to intervene as soon as possible to reduce the potential risk of arrhythmia and sudden cardiac death (SCD).
背景
校正 QT（QTc）间期延长是维持性血液透析（MHD）患者心脏性猝死的常见原因之一。然而，关于 MHD 患者 QTc 延长的研究较少。血液透析人群中乳酸脱氢酶（LDH）浓度升高，而 LDH 与 MHD 患者的死亡率相关。本研究旨在探讨 MHD 患者 QTc 间期延长与 LDH 的关系。
方法
这是一项横断面观察性研究。选取 2012 年 11 月至 2019 年 11 月南通大学第二附属医院接受 MHD 治疗超过 3 个月且资料完整的患者为研究对象。将患者分为正常 QTc 间期组和 QTc 间期延长组。回顾性从电子病历系统中收集患者的一般资料和临床实验室指标。采用 Pearson 相关分析和二元逻辑回归分析 LDH 与 QTc 间期延长的相关性；通过受试者工作特征（ROC）曲线计算预测 QTc 间期延长的 LDH 截断值。
结果
QTc 间期延长组 LDH 水平明显高于正常组（301.96±110.91 vs. 215.39±67.65，t=-8.03，P<0.001）。QTc 间期与 LDH 呈正相关（r=0.386）。二元逻辑回归分析显示，LDH、血清钾<4mmol/L、血清磷和左心室舒张末期直径（LVDd）是 QTc 间期延长的独立相关因素。ROC 曲线结果显示，LDH=220U/L 是预测 MHD 患者 QTc 间期延长的最佳截断点，灵敏度为 81.45%，特异度为 59.35%。二元逻辑回归分析显示，与 LDH≤220U/L 组相比，LDH>220U/L 组 QTc 间期延长的可能性增加 6.34 倍（OR 6.34，95%CI：3.47-11.58，P<0.001）。
结论
MHD 患者 LDH 与 QTc 间期延长密切相关。血清 LDH、离子钙、血清磷和钾可能预测 QTc 间期延长。监测相关指标可提醒临床医生尽快进行干预，降低心律失常和心源性猝死（SCD）的潜在风险。
Zotero 插件