主动脉弓钙化维持性血液透析患者QT离散度、心率变异性和心室晚电位变化的临床研究
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摘要
目的探讨主动脉弓钙化维持性血液透析患者QT离散度、心率变异性和心室晚电位变化。方法选择2014年1月~2017年12月广东医科大学附属第三医院进行维持性血液透析治疗的患者52例,根据患者是否存在主动脉弓钙化将其分为钙化组和非钙化组。比较两组患者的基本临床指标、QT离散度、心率变异性指标和心室晚电位。结果钙化组患者35例,非钙化组患者17例。与非钙化组比较,钙化组患者平均年龄更大,透析龄更长,平均脉压差更高,差异有统计学意义(P<0.05);钙化组患者的QT离散度(QTd)、校正的QT离散度(Q-Tcd)和二尖瓣舒张早期血流峰值与二尖瓣环舒张早期运动速度之比(E/E')值显著高于非钙化组,差异有统计学意义(P<0.05)。两组左心室射血分数(EF)值比较,差异无统计学意义(P>0.05);钙化组患者标准化低频功率(LFn)值和功率变异比值[低频功率(LF)/高频功率(HF)比值]均显著低于非钙化组,差异有统计学意义(P<0.05);两组患者标准化高频功率(HFn)值比较,差异无统计学意义(P>0.05)。结论 维持血液透析患者主动脉弓出现钙化会引起心脏QT离散度改变,心率变异性降低,且使得患者更加容易出现心室晚电位。
Objective To investigate the clinical significance of QT dispersion, heart rate variability and ventricular late potentials in patients with aortic arch calcification maintenance hemodialysis. Methods From January 2014 to December 2017, in the Third Affiliated Hospital of Guangdong Medical University, 52 patients with maintenance hemodialysis were selected, according to whether with or without aortic arch calcification, patients were divided into calcification group(35 cases) and non-calcification group(17 cases). The basic clinical indexes, QT dispersion, heart rate variability index and ventricular late potentials in two groups were compared. Results Compared with the non-calcification group, the average age of the patients in the calcification group was more, the mean duration of dialysis was longer, and the mean pulse pressure difference was higher, the differences were statistically significant(P < 0.05). The QTd, Q-Tcd and E/E' in the calcification group were significantly higher than those in the non-calcification group, the differences were statistically significant(P < 0.05). There was no significant difference in EF between the two groups(P > 0.05). The LFn value and LF/HF ratio in the calcification group were significantly lower than those in the non-calcification group, the differences were statistically significant(P < 0.05). There was no significant difference in HFn values between the two groups(P > 0.05). Conclusion Maintaining calcification of the aortic arch in hemodialysis patients can causes changes of cardiac QT dispersion, reduced heart rate variability, in order to make a greater likelihood of ventricular late potentials in patients.
Objective To investigate the clinical significance of QT dispersion, heart rate variability and ventricular late potentials in patients with aortic arch calcification maintenance hemodialysis. Methods From January 2014 to December 2017, in the Third Affiliated Hospital of Guangdong Medical University, 52 patients with maintenance hemodialysis were selected, according to whether with or without aortic arch calcification, patients were divided into calcification group(35 cases) and non-calcification group(17 cases). The basic clinical indexes, QT dispersion, heart rate variability index and ventricular late potentials in two groups were compared. Results Compared with the non-calcification group, the average age of the patients in the calcification group was more, the mean duration of dialysis was longer, and the mean pulse pressure difference was higher, the differences were statistically significant(P < 0.05). The QTd, Q-Tcd and E/E' in the calcification group were significantly higher than those in the non-calcification group, the differences were statistically significant(P < 0.05). There was no significant difference in EF between the two groups(P > 0.05). The LFn value and LF/HF ratio in the calcification group were significantly lower than those in the non-calcification group, the differences were statistically significant(P < 0.05). There was no significant difference in HFn values between the two groups(P > 0.05). Conclusion Maintaining calcification of the aortic arch in hemodialysis patients can causes changes of cardiac QT dispersion, reduced heart rate variability, in order to make a greater likelihood of ventricular late potentials in patients.
引文
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[6]周加军,刘彩欣,周健美,等.维持性血液透析患者血管反应性充血指数与心血管风险因子相关性研究[J].皖南医学院学报,2017,21(4):325-328.
[7]陈佩玲,龚德华,徐斌,等.维持性血液透析患者心血管钙化进展的相关影响因素分析[J].肾脏病与透析肾移植杂志,2017,36(5):403-407.
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[9]广建,陈锦海,林辉莉,等.左卡尼汀对老年血液透析患者左心室肥厚及QT离散度的影响[J].中国老年学杂志,2013,12(19):4735-4737.
[10]刘晓东,伏广浩,刘锦秀.高通量血液透析对维持性血液透析患者QT间期离散度的影响[J].现代医药卫生,2016,4(16):2568-2570.
[11]覃晓波.维持性血液透析患者心率变异性与室性心律失常的研究进展[J].实用心电学杂志,2015,25(3):209-212.
[12]泽雄,邹川,吴禹池,等.血液透析失眠患者的心率变异性与子午流注规律的关系探讨[J].世界科学技术:中医药现代化,2016,18(6):994-999.
[13]振达,成彩联,李梅,等.参松养心胶囊对维持性血液透析患者心率变异性和失眠的影响[J].中国现代医学杂志,2015,4(24):79-83.
[14]黄敏,杨春琴.维持性血液透析患者心血管疾病死亡的危险因素分析[J].中国药物与临床,2018,9(1):105-107.
[15]张琨,王少亭,胡晓舟,等.维持性血液透析患者并发心血管疾病危险因素分析[J].山东医药,2017,12(4):82-84.
[16]张晓艳,王晓玲,苑玉聪,等.维持性血液透析患者不同血红蛋白水平与住院率、心血管事件的相关性分析[J].湖南师范大学学报:医学版,2017,33(1):39-41.
[17]常美香,刘利萍,翁敏.营养不良-炎症综合征对维持性血液透析患者心血管钙化的影响[J].中国现代医学杂志,2017,17(4):110-115.
[18]陈佩玲,龚德华.维持性血液透析患者:高血磷、高血钙、高甲状旁腺素伴心血管钙化[J].肾脏病与透析肾移植杂志,2017,15(5):495-500.
[19]李春艳,闫朝丽.甲状旁腺功能减退症33例临床分析[J].疑难病杂志,2016,15(2):195-197.
[20]陈绮华.阿托伐他汀联合神经内分泌拮抗剂治疗慢性心力衰竭的临床疗效观察[J].中国医药科学,2016,6(11):103-105.
[21]张晓玲,白久旭,郝峻烽,等.老年维持性血液透析患者血管钙化与透析间低血压的相关性研究[J].中华保健医学杂志,2017,22(6):492-495.
[22]黎晓磊,孔耀中,肖观清,等.中长期血液透析联合血液灌流对维持性血液透析患者血管内皮功能的影响[J].实用医学杂志,2017,26(20):3437-3440.
[2]Kraus MA,Kalra PA,Hunter J,et al.The prevalence of vascular calcification in patients with end-stage renal disease on hemodialysis:a cross-sectional observational study[J].Ther Adv Chronic Dis,2015,6(3):84-96.
[3]Rahar KK,Pahadiya HR,Barupal KG,et al.The QT dispersion and QTc dispersion in patients presenting with acute neurological events and its impact on early prognosis[J].J Neurosci Rural Pract,2016,7(1):61-66.
[4]Papaioannou VE,Verkerk AO,Amin AS,et al.Intracardiac origin of heart rate variability,pacemaker funny current and their possible association with critical illness[J].Curr Cardiol Rev,2013,9(1):82-96.
[5]Genet M,Lee LC,Nguyen R,et al.Distribution of normal human left ventricular myofiber stress at end diastole and end systole:a target for in silico design of heart failure treatments[J].J Appl Physiol,2014,117(2):142-152.
[6]周加军,刘彩欣,周健美,等.维持性血液透析患者血管反应性充血指数与心血管风险因子相关性研究[J].皖南医学院学报,2017,21(4):325-328.
[7]陈佩玲,龚德华,徐斌,等.维持性血液透析患者心血管钙化进展的相关影响因素分析[J].肾脏病与透析肾移植杂志,2017,36(5):403-407.
[8]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,2013,7(10):65-66.
[9]广建,陈锦海,林辉莉,等.左卡尼汀对老年血液透析患者左心室肥厚及QT离散度的影响[J].中国老年学杂志,2013,12(19):4735-4737.
[10]刘晓东,伏广浩,刘锦秀.高通量血液透析对维持性血液透析患者QT间期离散度的影响[J].现代医药卫生,2016,4(16):2568-2570.
[11]覃晓波.维持性血液透析患者心率变异性与室性心律失常的研究进展[J].实用心电学杂志,2015,25(3):209-212.
[12]泽雄,邹川,吴禹池,等.血液透析失眠患者的心率变异性与子午流注规律的关系探讨[J].世界科学技术:中医药现代化,2016,18(6):994-999.
[13]振达,成彩联,李梅,等.参松养心胶囊对维持性血液透析患者心率变异性和失眠的影响[J].中国现代医学杂志,2015,4(24):79-83.
[14]黄敏,杨春琴.维持性血液透析患者心血管疾病死亡的危险因素分析[J].中国药物与临床,2018,9(1):105-107.
[15]张琨,王少亭,胡晓舟,等.维持性血液透析患者并发心血管疾病危险因素分析[J].山东医药,2017,12(4):82-84.
[16]张晓艳,王晓玲,苑玉聪,等.维持性血液透析患者不同血红蛋白水平与住院率、心血管事件的相关性分析[J].湖南师范大学学报:医学版,2017,33(1):39-41.
[17]常美香,刘利萍,翁敏.营养不良-炎症综合征对维持性血液透析患者心血管钙化的影响[J].中国现代医学杂志,2017,17(4):110-115.
[18]陈佩玲,龚德华.维持性血液透析患者:高血磷、高血钙、高甲状旁腺素伴心血管钙化[J].肾脏病与透析肾移植杂志,2017,15(5):495-500.
[19]李春艳,闫朝丽.甲状旁腺功能减退症33例临床分析[J].疑难病杂志,2016,15(2):195-197.
[20]陈绮华.阿托伐他汀联合神经内分泌拮抗剂治疗慢性心力衰竭的临床疗效观察[J].中国医药科学,2016,6(11):103-105.
[21]张晓玲,白久旭,郝峻烽,等.老年维持性血液透析患者血管钙化与透析间低血压的相关性研究[J].中华保健医学杂志,2017,22(6):492-495.
[22]黎晓磊,孔耀中,肖观清,等.中长期血液透析联合血液灌流对维持性血液透析患者血管内皮功能的影响[J].实用医学杂志,2017,26(20):3437-3440.