维持性血液透析患者电生理指标变化与心血管疾病的相关性研究
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摘要
目的观察维持性血液透析(MHD)患者的QT离散度(QTd)、心率震荡(HRT)和心室晚电位(VLP)的变化特点,探讨其与心血管疾病(CVD)的相关性。方法选取广东医科大学附属第三医院肾内科2009年7月至2017年2月收治的32例MHD患者作为观察组,以同期住院临床确诊为慢性肾脏疾病2~4期的30例患者作为对照组,所有患者就诊3 d内行QTd、HRT和VLP检测,并于观察期当月、第3和第6个月,采用同样方法重复检测3次,取其平均值作为参考。随访追踪1年内的主要CVD不良事件,所获得的数据应用SPSS17.0软件进行统计学分析。结果 (1)观察组患者的QTd为(46.54±25.75)ms,明显长于对照组的(30.58±16.62)ms,差异有显著统计学意义(P<0.01);HRT方面,相较对照组TO值(-1.38±1.59)、TS值(6.74±3.83),观察组TO值(0.89±0.97)升高,TS值(4.75±3.32)降低,差异有统计学意义(P<0.05);观察组患者的VLP阳性率为68.75%,明显高于对照组的33.33%,差异有显著统计学意义(P<0.01)。(2)随访追踪1年,观察组患者的充血性心力衰竭的发生率为62.5%,明显高于对照组的20.0%;心绞痛的发生率为40.6%,高于对照组的16.7%;心肌梗塞的发生率为28.1%,高于对照组的3.3%;猝死的发生率为25.0%,高于对照组的3.3%,差异均有统计学意义(P<0.01或P<0.05)。(3)将QTd、HRT和VLP作为自变量,以是否发生CVD不良事件作为因变量,纳入多元回归分析。结果显示,QTd、HRT和VLP与CVD间呈正相关,且差异有统计学意义(r=0.258、0.294、0.312,P<0.05)。结论维持性血液透析患者QTd、HRT和VLP变化明显,容易引起各类心血管疾病;QTd、HRT和VLP可作为一种无创、简易的电生理指标常规应用于MHD患者的临床检测。
Objective To evaluate the correlation between the cardiovascular disease(CVD) and the changes of cardiac electrophysiology in the patients with maintenance hemodialysis(MHD), by comparing the characteristics on the changes of QT dispersion(QTd), heart rate turbulence(HRT) and ventricular late potential(VLP). Methods A total of 32 patients with maintenance hemodialysis, who admitted into the Third Affiliated Hospital of Guangdong Medical University during July 2009 to February 2017, were selected as the observation group. At the same time, 30 patients who were diagnosed with chronic kidney disease in the stage of 2 to 4 were enrolled into the control group. The items of QTd,HRT and VLP were measured during the first 3 days. The same techniques were used at different time(the first month, the third month and the sixth month), taking the average value as a reference. The major adverse events of the cardiovascular disease within 1 year were tracked. The change of the parameters was analyzed by SPSS17.0. Results(1) The value of QTd in the observation group was(46.54±25.75) ms, which was significantly longer than(30.58±16.62) ms of the control group(P<0.01). The TO of the HRT was significantly elevated from(-1.38 ± 1.59) in the control group to(0.89±0.97) in the observation group(P<0.05), but the value of TS was reduced from(6.74±3.83) in the control group to(4.75 ± 3.32) in the observation group(P<0.05). The positive rate of VLP was 68.75% in the observation group versus33.33% in the control group(P<0.01).(2) Within one-year of follow-up, the incidence of congestive heart failure in the observation group was 62.5%, which was significantly higher than 20.0% in the control group(P<0.01). The incidence of angina, myocardial infarction and sudden death the observation group were 40.6%, 28.1%, 25.0%, respectively,which were significantly higher than corresponding 16.7%, 3.3%, 3.3% in the control group(P<0.05).(3) The multivariate regression analysis demonstrated that QTd, HRT and VLP were positively correlated with CVD(r=0.258, 0.294,0.312, P<0.05). Conclusion The changes of QTd, HRT and VLP were significant in the patients with maintenance hemodialysis, which can cause all kinds of the cardiovascular disease. As a noninvasive and simple electrophysiological index, QTd, HRT and VLP should be used routinely for clinical detection in the patients with maintenance hemodialysis.
Objective To evaluate the correlation between the cardiovascular disease(CVD) and the changes of cardiac electrophysiology in the patients with maintenance hemodialysis(MHD), by comparing the characteristics on the changes of QT dispersion(QTd), heart rate turbulence(HRT) and ventricular late potential(VLP). Methods A total of 32 patients with maintenance hemodialysis, who admitted into the Third Affiliated Hospital of Guangdong Medical University during July 2009 to February 2017, were selected as the observation group. At the same time, 30 patients who were diagnosed with chronic kidney disease in the stage of 2 to 4 were enrolled into the control group. The items of QTd,HRT and VLP were measured during the first 3 days. The same techniques were used at different time(the first month, the third month and the sixth month), taking the average value as a reference. The major adverse events of the cardiovascular disease within 1 year were tracked. The change of the parameters was analyzed by SPSS17.0. Results(1) The value of QTd in the observation group was(46.54±25.75) ms, which was significantly longer than(30.58±16.62) ms of the control group(P<0.01). The TO of the HRT was significantly elevated from(-1.38 ± 1.59) in the control group to(0.89±0.97) in the observation group(P<0.05), but the value of TS was reduced from(6.74±3.83) in the control group to(4.75 ± 3.32) in the observation group(P<0.05). The positive rate of VLP was 68.75% in the observation group versus33.33% in the control group(P<0.01).(2) Within one-year of follow-up, the incidence of congestive heart failure in the observation group was 62.5%, which was significantly higher than 20.0% in the control group(P<0.01). The incidence of angina, myocardial infarction and sudden death the observation group were 40.6%, 28.1%, 25.0%, respectively,which were significantly higher than corresponding 16.7%, 3.3%, 3.3% in the control group(P<0.05).(3) The multivariate regression analysis demonstrated that QTd, HRT and VLP were positively correlated with CVD(r=0.258, 0.294,0.312, P<0.05). Conclusion The changes of QTd, HRT and VLP were significant in the patients with maintenance hemodialysis, which can cause all kinds of the cardiovascular disease. As a noninvasive and simple electrophysiological index, QTd, HRT and VLP should be used routinely for clinical detection in the patients with maintenance hemodialysis.
引文
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[12]林茴,卓伟明,袁丽萍.慢性肾功能衰竭患者窦性心率震荡分析[J].岭南心血管病杂志,2015,21(4):510-512.
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[14]Femenia F,Arce M,Van Grieken J,et al.Fragmented QRS as a predictor of arrhythmic events in patients with hypertrophic obstructive cardiaomyopathy[J].J Interv Card Eletrophysiol,2013,38(3):159-165.
[15]王柳雯,李萍华,汤日祥.维持性血液透析患者血尿酸水平与心血管疾病的相关性[J].海南医学,2017,28(9):1413-1414.
[2]张硕,冷永群,卢佳佳,等.心率减速力及QT离散度对慢性心力衰竭患者心源性猝死的预测价值[J].实用心电学杂志,2015,24(3):197-199.
[3]孙喜文,陈海坚,吴小敏,等.微伏级T波电交替和窦性心率震荡在冠心病诊断中的临床应用[J].海南医学,2016,27(11):1759-1761.
[4]Yang XW,Hua W,Wang J,et al.Regression of fragmented QRS complex:a marker of electrical reverse remodeling in cardiac resynchronization therapy[J].Ann Noninvasive Eletrocardiol,2014,20(1):18-27.
[5]Levey AS,Coresh J.Chronic kidney disease[J].Lancet,2012,379:165-180.
[6]隋艳波,宋云飞,李洪岩.心力衰竭常见中医型与心率震荡及心功能相关性研究[J].实用中医药杂志,2013,29(7):593-594.
[7]李庆,赵玲.破碎QRS波在心血管疾病中诊断价值和临床应用研究进展[J].心血管病学进展,2015,36(3):292-296.
[8]袁江红,王文兵.血液透析和腹膜透析患者QT离散度比较[J].安徽医学,2015,36(2):188-190.
[9]李瑾瑜,覃晓波,陈晓婕.维持性血液透析患者透析前后QT离散度变化及其临床意义[J].中国实用医药,2013,8(10):65-66.
[10]荣春兰.动态心电图诊查室性期前收缩的昼夜变化及其临床意义[J].中外医学研究,2014,12(29):3-4.
[11]黎北林.血液灌流联合血液透析对尿毒症患者周围神经病变的疗效分析[J].齐齐哈尔医学院学报,2015,36(35):5377-5378.
[12]林茴,卓伟明,袁丽萍.慢性肾功能衰竭患者窦性心率震荡分析[J].岭南心血管病杂志,2015,21(4):510-512.
[13]王艳惠,冯淑芝.窦性心率震荡临床应用进展[J].医学综述,2012,18(4):545-547.
[14]Femenia F,Arce M,Van Grieken J,et al.Fragmented QRS as a predictor of arrhythmic events in patients with hypertrophic obstructive cardiaomyopathy[J].J Interv Card Eletrophysiol,2013,38(3):159-165.
[15]王柳雯,李萍华,汤日祥.维持性血液透析患者血尿酸水平与心血管疾病的相关性[J].海南医学,2017,28(9):1413-1414.