Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis.
Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis.
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DOI：
10.1371/journal.pone.0155445
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Ding X
中科院分区：
文献类型：
--
作者：
Nie Y;Zou J;Liang Y;Shen B;Liu Z;Cao X;Chen X;Ding X
心脏性猝死是慢性血液透析（HD）患者死亡的主要原因之一。QTc间期延长与心源性猝死发生率增加相关。本文的目的是评估心电图（ECG）中发现的异常，并探讨可能影响QTc间期的因素。本研究共入组了141例常规HD患者。在单次透析前和透析结束前15分钟（峰值负荷）对每例患者进行ECG检查。在透析治疗开始前进行超声心动图检查。在透析治疗前后立即通过静脉切开术抽取血样。透析前，93.62%的患者处于窦性心律，约65%的患者显示QTc间期延长（即，男性QTc间期高于440 ms，女性高于460 ms）。透析前和峰值负荷时ECG参数的比较显示心率（77.45±11.92 vs. 80.38±14.65 bpm，p = 0.001）和QTc间期（460.05±24.53 ms vs. 470.93±24.92 ms，p<0.001）增加。根据QTc间期将患者分为两组后，QTc间期延长组透析前血清钾（K+）、钙（Ca 2+）、磷、钙磷（Ca*P）浓度较低，血浆脑钠肽（BNP）浓度较高。该组患者的左心房直径（LAD）更大，室间隔更厚，并且他们往往比另一组患者年龄更大。根据ΔQTc（ΔQTc = QTc峰值负荷- QTc pre-HD）将患者分为两组。当分析峰值负荷时QTc间期较HD前延长的患者时，我们发现他们的Ca 2+和P5+浓度较高，K+、铁蛋白、UA和BNP浓度较低。他们也更有可能是女性。此外，该组心脏结构异常较多。多元回归分析显示，HD前和LAD前的血清Ca 2+浓度是QTc间期延长的独立变量。UA、铁蛋白和室间隔是ΔQTc的独立变量。QT间期延长在HD患者中非常常见，并与几个风险因素相关。应根据患者的临床状况选择适当浓度的透析液电解质。
Sudden cardiac death is one of the primary causes of mortality in chronic hemodialysis (HD) patients. Prolonged QTc interval is associated with increased rate of sudden cardiac death. The aim of this article is to assess the abnormalities found in electrocardiograms (ECGs), and to explore factors that can influence the QTc interval. A total of 141 conventional HD patients were enrolled in this study. ECG tests were conducted on each patient before a single dialysis session and 15 minutes before the end of dialysis session (at peak stress). Echocardiography tests were conducted before dialysis session began. Blood samples were drawn by phlebotomy immediately before and after the dialysis session. Before dialysis, 93.62% of the patients were in sinus rhythm, and approximately 65% of the patients showed a prolonged QTc interval (i.e., a QTc interval above 440 ms in males and above 460ms in females). A comparison of ECG parameters before dialysis and at peak stress showed increases in heart rate (77.45±11.92 vs. 80.38±14.65 bpm, p = 0.001) and QTc interval (460.05±24.53 ms vs. 470.93±24.92 ms, p<0.001). After dividing patients into two groups according to the QTc interval, lower pre-dialysis serum concentrations of potassium (K+), calcium (Ca2+), phosphorus, calcium* phosphorus (Ca*P), and higher concentrations of plasma brain natriuretic peptide (BNP) were found in the group with prolonged QTc intervals. Patients in this group also had a larger left atrial diameter (LAD) and a thicker interventricular septum, and they tended to be older than patients in the other group. Then patients were divided into two groups according to ΔQTc (ΔQTc = QTc peak-stress- QTc pre-HD). When analyzing the patients whose QTc intervals were longer at peak stress than before HD, we found that they had higher concentrations of Ca2+ and P5+ and lower concentrations of K+, ferritin, UA, and BNP. They were also more likely to be female. In addition, more cardiac construction abnormalities were found in this group. In multiple regression analyses, serum Ca2+ concentration before HD and LAD were independent variables of QTc interval prolongation. UA, ferritin, and interventricular septum were independent variables of ΔQTc. Prolonged QT interval is very common in HD patients and is associated with several risk factors. An appropriate concentration of dialysate electrolytes should be chosen depending on patients’ clinical conditions.