乙型肝炎肝硬化心肌病的心电特点、影像学表现及预后影响因素

摘要/Abstract

摘要： 目的分析乙型肝炎肝硬化心肌病的心电特点、影像学表现及预后影响因素,为改善患者预后提供依据。方法回顾性纳入2021年4月至2023年4月空军军医大学第一附属医院收治的65例乙型肝炎肝硬化患者,根据是否发生乙型肝炎肝硬化心肌病分为发生组(40例)和对照组(25例),根据随访1年后随访情况将发生组分为预后良好组(25例,失访1例)和不良组(13例,失访1例)。检测患者血肌酐(Scr)、血红蛋白(Hb)、凝血酶原时间(PT)水平,使用彩色多普勒超声诊断仪检测影像学特征,使用心电图机进行心电图检查。比较发生组、对照组影像学、心电图检查指标。采用多因素logistic分析乙型肝炎肝硬化心肌病预后的影响因素。结果发生组的左心房内径(LAD)、舒张期室间隔厚度(IVSD)、Q-T间期延长、ST-T改变、低电压占比分别为(39.2±4.6)mm、(12.8±1.5)mm、75.0%、70.0%、30.0%,均高于对照组[分别为(34.2±2.8)mm、(10.5±1.1)mm、36.0%、28.0%、8.0%]; E/A比值为(0.7±0.1),低于对照组[(1.4±0.3),P<0.05]。不良组Child-Pugh分级C级、Q-T间期延长、ST-T改变、低电压占比分别为69.2%、61.5%、53.9%、61.5%,明显高于生存组[分别为20.0%、16.0%、8.0%、12.0%,P<0.05]。多因素logistic回归分析结果显示,Child-Pugh分级、Q-T间期延长、ST-T改变、低电压是影响乙型肝炎肝硬化心肌病患者预后的因素(OR=3.490、3.842、3.466、3.684,P<0.05)。结论 Child-Pugh分级、Q-T间期延长、ST-T改变、低电压是影响乙型肝炎肝硬化心肌病患者预后的因素。

关键词: 乙型肝炎肝硬化, 心肌病, 心电特点, 预后, 影响因素

Abstract: Objective To analyze the electrocardiographic characteristics, imaging manifestations and prognostic influencing factors of hepatitis B-related cirrhotic cardiomyopathy, and to provide a basis for improving the prognosis of patients. Methods Sixty-five patients with hepatitis B-related liver cirrhosis admitted to First Affiliated Hospital of Air Force Medical University from April 2021 to April 2023 were enrolled in this study. According to whether they developed hepatitis B-related cirrhotic cardiomyopathy, they were divided into an occurrence group (n=40) and a control group (n=25). The occurrence group was further classified into a good prognosis group (25 cases, 1 case of lossing follow-up) and a poor prognosis group (13 cases , 1 case of lossing follow-up). Blood creatinine (Scr) and hemoglobin (Hb) were detected using a fully automated biochemical immunoassay analyzer; prothrombin time (PT) was detected using a fully automated coagulation analyzer; imaging features were detected using a color Doppler ultrasound diagnostic machine; and electrocardiography was performed using an electrocardiograph. The imaging and electrocardiogram examination indexes in the occurrence group and control group were compared. The influencing factors for the prognosis of hepatitis B-related cirrhotic cardiomyopathy were analyzed using multifactorial logistics. Results The left atrial inner diameter (LAD), diastolic ventricular septal thickness (IVSD), Q-T interval prolongation, ST-T changes, and the percentage of low voltage in the occurrence group were (39.2±4.6) mm, (12.8±1.5) mm, 75.0%, 70.0%, and 30.0% in the occurrence group, respectively, which were higher than those of [(34.2±2.8) mm, (10.5±1.1) mm, 36.0%, 28.0%, and 8.0%] in the control group. The E/A ratio was (0.7±0.1) in the occurrence group, which was lower than that of (1.4±0.3) in the control group (P<0.05). The percentages of Child-Pugh classification C, Q-T interval prolongation, ST-T changes, and low voltage in the adverse group were 69.2%, 61.5%, 53.9%, and 61.5%, respectively, which were significantly higher than those of 20.0%, 16.0%, 8.0%, and 12.0% in the survival group (P<0.05). The results of multifactorial logistic regression analysis showed that Child-Pugh classification, Q-T interval prolongation, ST-T changes, and low voltage were factors affecting the prognosis of patients with hepatitis B-related cirrhotic cardiomyopathy (OR=3.490, 3.842, 3.466, 3.684, respectively, P<0.05). Conclusion Child-Pugh classification, Q-T interval prolongation, ST-T changes, and low voltage are factors affecting the prognosis of patients with hepatitis B-related cirrhotic cardiomyopathy.

Key words: Hepatitis B cirrhosis, Cardiomyopathy, Electrocardiographic features, Prognosis, Influencing factors

朱颖, 牛静, 徐远平, 帖君. 乙型肝炎肝硬化心肌病的心电特点、影像学表现及预后影响因素[J]. 肝脏, 2026, 31(3): 351-355.

ZHU Ying, NIU Jing, XU Yuan-ping, TIE Jun. The electrocardiographic features, imaging manifestations and prognostic influencing factors of hepatitis B-related cirrhotic cardiomyopathy[J]. Chinese Hepatolgy, 2026, 31(3): 351-355.

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