100例HBV感染肝硬化患者心电图检查QTc间期与其Child-Pugh评分的相关性研究

doi:10.19871/j.cnki.xfcrbzz.2023.01.013

摘要/Abstract

摘要： 目的研究乙型肝炎病毒（HBV）感染肝硬化患者心电图（ECG）检查QTc间期与其肝功能分级（Child-Pugh）评分的相关性,为其在诊断HBV感染肝硬化患者心肌病变中的应用提供参考和依据。方法以2020年1月至2021年12月贺州市人民医院收治的100例HBV感染肝硬化患者作为肝硬化组,选取同期在贺州市人民医院接受体检的97例健康体检者作为健康对照组,所有人员均进行ECG检查,根据Child-Pugh评分将100例HBV感染肝硬化患者分为A组（28例,Child-Pugh评分5~6分）、B组（40例,Child-Pugh评分7~9分）、C组（32例,Child-Pugh评分10~15分）。统计健康体检者与不同Child-Pugh评分HBV感染肝硬化患者一般资料,比较健康体检者、HBV感染肝硬化患者ECG检查QTc间期指标及不同Child-Pugh评分HBV感染肝硬化患者ECG检查QTc间期指标,采用Spearman检验分析ECG检查QTc间期指标与HBV感染肝硬化患者Child-Pugh评分及实验室指标的相关性。结果健康对照组、A组、B组、C组血清总胆红素（TBil）、白蛋白（ALB）、球蛋白（GLB）水平、心率呈逐渐升高趋势,凝血酶原时间（PT）呈逐渐延长趋势,ALT、AST水平呈先升高后降低再升高趋势,白蛋白/球蛋白（A/G)呈先降低后升高趋势,A、B、C组血清空腹血糖（FBG）、餐后2h血糖（2h BG）、肌酸激酶（CK）、高敏肌钙蛋白T（hs-TnT）水平呈逐渐升高趋势,健康对照组血清FBG、2h BG、CK、hs-TnT水平高于B、C组,组间比较,差异均具有统计学意义（P<0.05）。肝硬化组QTc、QT间期离散度（QTd）、校正QT间期离散度（QTcd）显著长于健康对照组（P<0.05）,QTc异常率（56.00%）显著高于健康对照组（9.28%,P<0.05）。A组、B组、C组QTc、QTd、QTcd呈逐渐延长趋势,组间比较,差异具有统计学意义（P<0.05）,QTc异常率（21.43%、50.00%、93.75%）呈逐渐升高趋势,组间比较,差异具有统计学意义（P<0.05）。QTc、QTd、QTcd及QTc异常率与HBV感染肝硬化患者Child-Pugh评分均呈显著正相关关系（r=0.673、0.588、0.498、0.529,P<0.05）。结论 HBV感染肝硬化患者存在QTc、QTd、QTcd延长,随着患者Child-Pugh评分增加,QTc、QTd、QTcd延长,QTc异常率升高,QTc、QTd、QTcd及QTc异常率与HBV感染肝硬化患者Child-Pugh评分呈正相关。

关键词: 肝硬化, 乙型肝炎病毒, 感染, 心电图, 校正QT间期

Abstract: Objective To study the correlation between electrocardiogram (ECG) correction of QT (QTc) interval and score of Child-Pugh in 100 patients with hepatitis B virus (HBV) infected cirrhosis, and to provide reference and basis for its application in the diagnosis of cardiomyopathy in patients with HBV infected cirrhosis. Method A total of 100 patients with HBV infected cirrhosis admitted to Hezhou People's Hospital from January 2020 to December 2021 were selected as the cirrhosis group, and 97 healthy subjects who underwent physical examination in the same period of Hezhou People's Hospital were selected as the healthy control group. All of them underwent ECG examination. According to Child-Pugh, 100 HBV-infected cirrhosis patients were divided into the group A (28 cases), the group B (40 cases) and the group C (32 cases). The general data of healthy physical examination subjects and HBV-infected cirrhosis patients with different score of Child-Pugh were collected, and the ECG QTc interval indexes of healthy physical examination subjects and HBV-infected cirrhosis patients with different score of Child-Pugh were compared. Spearman test was used to analyze the correlation between QTc interval index detected by ECG and score of Child-Pugh and laboratory index in patients with HBV-infected cirrhosis. Result The serum levels of total bilirubin (TBil), albumin (ALB), globulin (GLB) and heart rate in the healthy control group, the group A, the group B and the group C showed a gradually increasing trend, the prothrombin time (PT) showed a gradually lengthening trend, and the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) showed a trend of first increasing, then decreasing and then increasing. Albumin/globulin (A/G) was firstly decreased and then increased, while levels of serum fasting blood glucose (FBG), 2h postmeal blood glucose (2h BG), creatine kinase (CK) and high-sensitive troponin T (hs-TnT) in the groups A, B and C showed a gradual increasing trend. The serum levels of FBG, 2h BG, CK and hs-TnT in the healthy control group were higher than those in the group B and C, and the differences were statistically significant (P<0.05). The QTc, QT interval dispersion (QTd) and corrected QT interval dispersion (QTcd) in the cirrhosis group were significantly higher than those in the healthy control group (P<0.05), and the abnormal rate of QTc in the cirrhosis group (56.00%) was significantly higher than that in the healthy control group (9.28%, P<0.05). QTc, QTd and QTcd in the groups A, B and C showed a trend of gradual extension, and the difference between groups was statistically significant (P<0.05), while the abnormal rate of QTc (21.43%, 50.00%, 93.75%) showed a trend of gradual increase, and the difference between groups was statistically significant (P<0.05). The abnormal rates of QTc, QTd, QTcd and QTc were significantly positively correlated with score of Child-Pugh in HBV-infected patients with cirrhosis (r=0.673, 0.588, 0.498, 0.529, P<0.05). Conclusion HBV-infected patients with cirrhosis had prolonged QTc, QTd and QTcd. With the increase of patient score of Child-Pugh, QTc, QTd and QTcd are prolonged, and the abnormal rate of QTc increases. The abnormal rates of QTc, QTd, QTcd and QTc were significantly positively correlated with score of Child-Pugh in HBV-infected patients with cirrhosis.

Key words: Liver cirrhosis, Hepatitis B virus, Infection, Electrocardiogram, Check the corrected QT interval

中图分类号:

廖廷姝, 李钊, 邱婷, 陈瑞华. 100例HBV感染肝硬化患者心电图检查QTc间期与其Child-Pugh评分的相关性研究[J]. 新发传染病电子杂志, 2023, 8(1): 60-65.

Liao Tingshu, Li Zhao, Qiu Ting, Chen Ruihua. Study on the correlation between electrocardiogram QTc interval and score of Child-Pugh in 100 patients with HBV-infected cirrhosis[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(1): 60-65.

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