【作者】 丁筱雪；

【导师】 张赛丹；

【作者基本信息】 中南大学 ， 内科学， 2012， 博士

【摘要】 目的探讨QT离散度在急性肺栓塞患者与正常人的差异,治疗前后的动态变化及其与肺栓塞患者住院期间短期预后的关系。方法收集2011年5月至2012年4月我院急性肺栓塞患者42例,入院24小时内及治疗后分别行同步十二导联心电图检查,手工测量QT间期,并计算出QT离散度(QT dispersion,QTd)及心率校正的QT离散度(heart rate-corrected QT dispersion,QTcd),短期随访患者住院期间生存情况。同时期按年龄与性别匹配的健康体检者30例为正常对照组。结果QTd及QTcd在高危组(70.2±34.0ms)(88.1±43.3ms)及非高危组(49.3±21.8ms)(59.1±26.2ms)均显著大于正常对照组(33.2±12.4ms)(36.7±14.2ms)(P<0.05)；高危组显著大于非高危组(P<0.05)。前后两次心电图间隔5.6±2.5天。治疗后生存组QTd及QTcd (41.O±16.4ms)(47.4±18.0ms)较入院时(54.0±33.Oms)(67.2±40.5ms)显著减小(P<0.05),但仍大于正常组(P<0.05),死亡组治疗前后QTd及QTcd差异不显著。ROC曲线示治疗后的QTd及QTcd分别取最佳截点值51.5ms和58.1ms时,预测死亡敏感性为63.6%及81.8%,特异性为80%及88%。单因素及多元logistic回归分析表明入院时高危、存在右室功能障碍、治疗后QTcd仍大于正常范围是住院期间死亡的主要影响因素。结论1.急性肺栓塞患者QTd及QTcd显著高于正常人,入院时危险分层越高,QTd及QTcd越大；2.急性肺栓塞患者住院期间QTd及QTcd呈动态变化,经过治疗QTd及QTcd有所回落；3.合并右室功能障碍、入院时危险度高及治疗后QTcd大于正常范围者,住院期间短期预后不良。更多还原

【Abstract】 ObjectiveTo compare QT dispersion measurements in acute pulmonary embolism (PE) patients and normal subjects. To observe the alteration and the clinical significance of QT dispersion (QTd or QTcd) in acute pulmonary embolism.MethodsA total of42patients with PE and30age and gender matched normal subjects were studied. Patients were divided into high-risk group and non-high-risk group according to the state on admission. QT interval was measured manually in12-lead conventional electrocardiogram within24hours on admission as well as after treatment. QT dispersion (QTd) and heart rate-corrected QT dispersion were also calculated. All patients had been followed up in-hospital course.ResultsQTd and QTcd were significantly higher in high-risk group and non-high-risk group than in the normal subjects, while the same in high-risk group and non-high-risk group(70.2±34.0ms,49.3±21.8ms,33.2±12.4ms, P<0.05, in QTd)(88.1±43.3ms,59.1±26.2ms,36.7±14.2ms, P<0.05, in QTcd). The twice electrocardiograms were separated for5.6±2.5days. There were no difference in early QTd or QTcd between the patients who died and the survivors. QTd and QTcd fell significantly from early to late ECG in survivors, but not in patients who die(54.0±33.0ms vs41.0±16.4ms P<0.05, in QTd)(67.2±40.5ms vs47.4±18.0ms P<0.05,in QTcd). Based on receiver-operator characteristic curves a QTd≥51.5ms or a QTcd≥58.1ms could predict death in-hospital course with sensitivities of63.6%and80%, specificities of81.8%and88%. Logistic regression showed that hight-risk group, the presence of right ventricular dysfunction (RVD) and QTcd after treatment above normal range were the main risk factors of death in-hospital course.Conclusion1.QTd and QTcd were higher in PE patients than in normal subjects, the server of situation on admission the higher of QTd and QTcd.2.During the process of treatment QTd and QTcd has been decreased in survivors.3. High-risk group, right ventricular dysfunction and QTcd after treatment above normal range suggested of weakness prognosis in PE.更多还原