慢性肾脏病与QRST夹角相关性
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摘要
目的探索慢性肾脏病(CKD)与心电图QRST夹角关系。方法于2017年9月,在辽宁省朝阳市农村随机选择≥40岁农村居民作为研究对象,进行问卷调查、体格检查、心电图检查和血液检查。通过CKD-EPI公式计算估计肾小球滤过率(e GFR);通过12导联心电图获取平面QRST夹角,平面QRST夹角以95%分位(79°)作为分割点进行分组,> 79°定义为异常。采用logistic回归分析慢性肾脏病与QRST夹角异常的相关性。结果在最终纳入研究的4 258人中,CKD患者共69例(1.62%),与非CKD组比较,CKD组患者QRST夹角增大(26°vs 18°,P <0.05);调整血钾、甘油三酯、高密度脂蛋白、收缩压、心率、吸烟、腰围、血红蛋白、脑梗死等影响因素后,慢性肾脏病是QRST夹角异常的独立危险因素(OR=2.32,95%CI=1.06～5.04)。结论在普通人群中,慢性肾脏病与心电图平面QRST夹角异常显著相关,平面QRST夹角可预测慢性肾脏病进程。
Objective To explore the association between electrocardiographic QRST angle and chronic kidney disease(CKD) in middle aged and elderly rural populations. Methods We conducted a cross-sectional survey, including questionnaire interview, physical examination, and electrocardiogram and blood tests, among 4 258 rural residents aged 40 years and older recruited with cluster sampling in 16 villages of Chaoyang municipality, Liaoning province in September2017. The estimated glomerular filtration(eGFR) of the participants was calculated with CDK-epidemiology collaboration(CDK-EPI) formula and the participants with the eGFR of < 60 ml/minute/1.73 m2 CDK were considered as with renal insufficiency. The plane QRST angle was obtained with a 12-lead electrocardiogram(ECG), and the cut-off point of QRST angle is 95% quintile(79°) and the values greater than 79° were judged as abnormal QRST angle. The correlation between CDK and QRST angle was assessed with logistic regression analysis. Results Of all the participants, 69(1.62%) were identified with CKD. A significant greater QRST angle was observed among the participants with CKD than among those without CDK(26° vs. 18°, P < 0.05). Abnormal QRST angle was a independent risk factor for CDK after adjusting for serum potassium, triglyceride, high-density lipoprotein cholesterol, systolic blood pressure, heart rate, smoking, waist circumference,hemoglobin, and cerebral infarction(odds ratio = 2.32, 95% confidence interval: 1.06 – 5.04). Conclusion Increased electrocardiographic QRST angle is significantly associated with chronic kidney disease in general population and plane QRST angle could be used as a predicator for the process of chronic kidney disease.
Objective To explore the association between electrocardiographic QRST angle and chronic kidney disease(CKD) in middle aged and elderly rural populations. Methods We conducted a cross-sectional survey, including questionnaire interview, physical examination, and electrocardiogram and blood tests, among 4 258 rural residents aged 40 years and older recruited with cluster sampling in 16 villages of Chaoyang municipality, Liaoning province in September2017. The estimated glomerular filtration(eGFR) of the participants was calculated with CDK-epidemiology collaboration(CDK-EPI) formula and the participants with the eGFR of < 60 ml/minute/1.73 m2 CDK were considered as with renal insufficiency. The plane QRST angle was obtained with a 12-lead electrocardiogram(ECG), and the cut-off point of QRST angle is 95% quintile(79°) and the values greater than 79° were judged as abnormal QRST angle. The correlation between CDK and QRST angle was assessed with logistic regression analysis. Results Of all the participants, 69(1.62%) were identified with CKD. A significant greater QRST angle was observed among the participants with CKD than among those without CDK(26° vs. 18°, P < 0.05). Abnormal QRST angle was a independent risk factor for CDK after adjusting for serum potassium, triglyceride, high-density lipoprotein cholesterol, systolic blood pressure, heart rate, smoking, waist circumference,hemoglobin, and cerebral infarction(odds ratio = 2.32, 95% confidence interval: 1.06 – 5.04). Conclusion Increased electrocardiographic QRST angle is significantly associated with chronic kidney disease in general population and plane QRST angle could be used as a predicator for the process of chronic kidney disease.
引文
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[7]Chen S,Hoss S,Zeniou V,et al.Electrocardiographic predictors of morbidity and mortality in patients with acute myocarditis:the importance of QRS-T angle[J].J Card Fail,2018,24(1):3-8.
[8]May O,Graversen CB,Johansen M?,et al.A large frontal QRS-Tangle is a strong predictor of the long-term risk of myocardial infarction and all-cause mortality in the diabetic population[J].JDiabetes Complications,2017,31(3):551-555.
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[12]Zhang ZM,Prineas RJ,Case D,et al.Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality(from the atherosclerosis risk in communities study)[J].Am J Cardiol,2007,100(5):844-849.
[13]Waks JW,Tereshchenko LG,Parekh RS.Electrocardiographic predictors of mortality and sudden cardiac death in patients with end stage renal disease on hemodialysis[J].J Electrocardiol,2016,49(6):848-854.
[14]Tereshchenko LG,Kim ED,Oehler A,et al.Electrophysiologic substrate and risk of mortality in incident hemodialysis[J].J Am Soc Nephrol,2016,27(11):3413-3420.
[15]de Bie MK,Koopman MG,Gaasbeek A,et al.Incremental prognostic value of an abnormal baseline spatial QRS-T angle in chronic dialysis patients[J].Europace,2013,15(2):290-296.
[16]Jaroszynski A,Wysokinski A,Bednarek-Skublewska A,et al.The effect of a single dialysis session on spatial QRS-T angle in haemodialysis patients[J].Nephrol Dial Transplant,2010,25(11):3723-3729.
[17]刘力生.中国高血压防治指南2010[J].中国医学前沿杂志:电子版,2011(05):42-93.
[18]American Diabetes Association.Standards of medical care in diabetes-2010[J].Diabetes Care,2010,33(Suppl 1):S11-S61.
[19]Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.
[20]Aro AL,Huikuri HV,Tikkanen JT,et al.QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population[J].Europace,2012,14(6):872-876.
[21]Edwards NC,Moody WE,Chue CD,et al.Defining the natural history of uremic cardiomyopathy in chronic kidney disease:the role of cardiovascular magnetic resonance[J].JACC Cardiovasc Imaging,2014,7(7):703-714.
[22]Robinson TG,Carr SJ.Cardiovascular autonomic dysfunction in uremia[J].Kidney Int,2002,62(6):1921-1932.
[2]Coresh J,Selvin E,Stevens LA,et al.Prevalence of chronic kidney disease in the United States[J].JAMA,2007,298(17):2038-2047.
[3]Ramesh S,Zalucky A,Hemmelgarn BR,et al.Incidence of sudden cardiac death in adults with end-stage renal disease:a systematic review and meta-analysis[J].BMC Nephrol,2016,17(1):78.
[4]Matsushita K,Coresh J,Sang Y,et al.Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes:a collaborative meta-analysis of individual participant data[J].Lancet Diabetes Endocrinol,2015,3(7):514-525.
[5]Gansevoort RT,Correa-Rotter R,Hemmelgarn BR,et al.Chronic kidney disease and cardiovascular risk:epidemiology,mechanisms,and prevention[J].Lancet,2013,382(9889):339-352.
[6]Zhang X,Zhu Q,Zhu L,et al.Spatial/frontal QRS-T angle predicts all-cause mortality and cardiac mortality:a meta-analysis[J].PLoSOne,2015,10(8):e136174.
[7]Chen S,Hoss S,Zeniou V,et al.Electrocardiographic predictors of morbidity and mortality in patients with acute myocarditis:the importance of QRS-T angle[J].J Card Fail,2018,24(1):3-8.
[8]May O,Graversen CB,Johansen M?,et al.A large frontal QRS-Tangle is a strong predictor of the long-term risk of myocardial infarction and all-cause mortality in the diabetic population[J].JDiabetes Complications,2017,31(3):551-555.
[9]Jogu HR,O'Neal WT,Broughton ST,et al.Frontal QRS-T angle and the risk of atrial fibrillation in the elderly[J].Ann Noninvasive Electrocardiol,2017,22(2).
[10]Li SN,Zhang XL,Cai GL,et al.Prognostic significance of frontal QRS-T angle in patients with idiopathic dilated cardiomyopathy[J].Chin Med J(Engl),2016,129(16):1904-1911.
[11]Gotsman I,Shauer A,Elizur Y,et al.Temporal changes in electrocardiographic frontal QRS-T angle and survival in patients with heart failure[J].PLoS One,2018,13(3):e194520.
[12]Zhang ZM,Prineas RJ,Case D,et al.Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality(from the atherosclerosis risk in communities study)[J].Am J Cardiol,2007,100(5):844-849.
[13]Waks JW,Tereshchenko LG,Parekh RS.Electrocardiographic predictors of mortality and sudden cardiac death in patients with end stage renal disease on hemodialysis[J].J Electrocardiol,2016,49(6):848-854.
[14]Tereshchenko LG,Kim ED,Oehler A,et al.Electrophysiologic substrate and risk of mortality in incident hemodialysis[J].J Am Soc Nephrol,2016,27(11):3413-3420.
[15]de Bie MK,Koopman MG,Gaasbeek A,et al.Incremental prognostic value of an abnormal baseline spatial QRS-T angle in chronic dialysis patients[J].Europace,2013,15(2):290-296.
[16]Jaroszynski A,Wysokinski A,Bednarek-Skublewska A,et al.The effect of a single dialysis session on spatial QRS-T angle in haemodialysis patients[J].Nephrol Dial Transplant,2010,25(11):3723-3729.
[17]刘力生.中国高血压防治指南2010[J].中国医学前沿杂志:电子版,2011(05):42-93.
[18]American Diabetes Association.Standards of medical care in diabetes-2010[J].Diabetes Care,2010,33(Suppl 1):S11-S61.
[19]Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.
[20]Aro AL,Huikuri HV,Tikkanen JT,et al.QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population[J].Europace,2012,14(6):872-876.
[21]Edwards NC,Moody WE,Chue CD,et al.Defining the natural history of uremic cardiomyopathy in chronic kidney disease:the role of cardiovascular magnetic resonance[J].JACC Cardiovasc Imaging,2014,7(7):703-714.
[22]Robinson TG,Carr SJ.Cardiovascular autonomic dysfunction in uremia[J].Kidney Int,2002,62(6):1921-1932.