肝硬化患者QTc间期延长的危险因素

摘要/Abstract

摘要： 目的探讨肝硬化患者QTc间期延长的危险因素,为临床诊疗活动中采取适当的干预措施提供依据,以期降低患者发生QTc间期延长的风险。方法回顾性收集2020年1月至2023年12月于湖南省人民医院(湖南师范大学附属第一医院)住院期间诊断为肝硬化的648例患者资料,根据QTc间期是否延长,分为<440 ms组(275例)和≥440 ms组(373例)。比较两组患者的临床特征、实验室检测及检查指标,对肝硬化患者发生QTc间期延长进行相关危险因素分析。结果 Child-Pugh评分、中-大量腹水、高血压、左室舒张末期内径(LVEDD)、舒张末期左室后壁厚度(LVPWd)、二尖瓣膜口舒张晚期时快速充盈的充盈峰(A峰)、血红蛋白(Hb)、血小板(PLT)、凝血酶原活动度(PTA)、白蛋白(Alb)、球蛋白(GLB)、总胆红素(TBil)、总胆汁酸(TBA)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、钾(K)、钠(Na)、钙(Ca)及心型肌酸激酶(CK-MB)差异均有统计学意义(P<0.05)。单因素分析中,上述指标差异均有统计学意义(P<0.05)。多因素二元logistic回归分析结果显示,高血压、LVPWd、A峰、Hb、GLB、K是肝硬化患者发生QTc间期延长的独立影响因素(OR分别为2.145、1.178、3.772、0.990、1.044、0.639,P<0.05)。以LVPWd、A峰、Hb、GLB、K及联合变量(五个变量综合)为检验变量绘制ROC曲线,结果显示曲线下面积(AUC)分别为0.700、0.565、0.602、0.625、0.614、0.573。结论高血压、LVPWd、A峰、Hb、GLB、K是肝硬化患者QTc间期延长的独立影响因素,临床工作中应高度重视这些指标,及时制定并采取有效的干预措施,降低患者QTc间期延长发生的风险。

关键词: 肝硬化, 心电图, QTc间期, 危险因素

Abstract: Objective To explore the risk factors for the occurrence of QTc interval prolongation in patients with liver cirrhosis, so as to provide a basis for taking appropriate intervention measures in clinical diagnosis and treatment activities, with the aim of reducing the risk of QTc interval prolongation in cirrhotic patients. Methods The data of 648 patients diagnosed with liver cirrhosis during their hospitalization in People′s Hospital of Hunan Province (the First Affiliated Hospital of Hunan Normal University) from January 2020 to December 2023 were retrospectively collected. According to whether the QTc interval was prolonged or not, the patients were divided into a group with QTc interval < 440 ms (275 cases) and a group with QTc interval ≥ 440 ms (373 cases). The clinical characteristics, laboratory tests and examination indicators of the patients in these two groups were compared, and the relevant risk factors for the occurrence of QTc interval prolongation in patients with liver cirrhosis were analyzed. Results By comparing the data of the patients in the two groups and performing univariate logistic regression analysis, it was shown that there were statistically significant differences in Child-Pugh score, moderate to massive ascites, hypertension, left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness at end-diastolic (LVPWd), filling peak of rapid filling during late diastole of the mitral valve orifice (A wave), hemoglobin (Hb), platelet (PLT), prothrombin activity (PTA), albumin (Alb), globulin (GLB), total bilirubin (TBil), total bile acid (TBA), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), potassium (K), sodium (Na), calcium (Ca) and creatine kinase-MB (CK-MB) (P<0.05). Univariate analysis showed that all of the above-mentioned indicators were statistically significant (P<0.05).The results of multivariate binary logistic regression analysis showed that hypertension, LVPWd, A peak, Hb, GLB, and K were independent influencing factors for the prolongation of the QTc interval in patients with liver cirrhosis (with odds ratios of 2.145, 1.178, 3.772, 0.990, 1.044, 0.639 respectively, P<0.05). ROC curves were plotted with LVPWd, A peak, Hb, GLB, K and the combined variable (a combination of the five variables) as the test variables. The results showed that the areas under the curve (AUC) were 0.700, 0.565, 0.602, 0.625, 0.614 and 0.573 respectively. Conclusion Hypertension, LVPWd, A peak, Hb, GLB, and K are independent influencing factors for the prolongation of the QTc interval in cirrhotic patients. These indicators should be highly emphasizedand effectively intervented s in clinical work, hould be promptly formulated and implemented to reduce the risk of QTc interval prolongation in patients.

Key words: Liver cirrhosis, Electrocardiogram, QTc interval, Risk factors

蒋花叶, 范咏梅. 肝硬化患者QTc间期延长的危险因素[J]. 肝脏, 2026, 31(8): 1101-1106.

Jiang Huaye, Fan Yongmei. The risk factors of QTc interval prolongation in patients with liver cirrhosis[J]. Chinese Hepatolgy, 2026, 31(8): 1101-1106.

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