Correlation between Child-Pugh classification and electrocardiogram variation in patients of Wilson ' s disease with cirrhosis
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摘要:
目的 比较肝豆状核变性(WD)合并肝硬化患者Child-Pugh分级与心脏功能的相关参数，探讨该类患者极早期心电图变异情况。 方法 选取2022年6月—2023年7月安徽中医药大学第一附属医院收治的98例肝豆状核变性合并肝硬化患者作为观察组，计算Child-Pugh评分并根据其分级分为A、B、C三个亚组；选取同期医院体检者98例为健康对照组。收集并比较2组患者心电图参数，探讨Child-Pugh分级与WD患者心电图变异的相关性。 结果 (1) 观察组心电图异常率(84.69%)高于健康对照组(25.51%)，差异有统计学意义(P＜0.05)。(2)健康对照组心率为(68.11±3.95)次/min、QRS时限为(91.09±4.55)ms，观察组心率为(75.57±6.56)次/min、QRS时限为(102.23±7.98)ms，对照组均小于观察组，差异有统计学意义(P＜0.01)。(3)与A亚组相比，B亚组和C亚组心率加快，QRS时限、QT、QTc间期延长，差异有统计学意义(P＜0.01)。(4)Spearman相关分析显示，Child-Pugh分级与心率(r=0.740，P＜0.001)、QRS时限(r=0.495，P＜0.001)、QT期间(r=0.442，P＜0.001)、QTc间期(r=0.490，P＜0.001)呈正相关关系，与P-R间期(r=-0.433，P＜0.001)呈负相关关系。 结论 肝豆状核变性合并肝硬化患者较常人更易出现非特异性心电图异常，且肝硬化严重程度与心电图变异性存在一定的关系。 -
关键词:
- 肝豆状核变性 /
- 肝硬化 /
- Child-Pugh分级 /
- 心电图
Abstract:Objective To compare the related parameters of Child-Pugh classification and cardiac function in patients with hepatolenticular degeneration and cirrhosis, and to explore the variation of electrocardiogram in the very early stage of these patients. Methods A total of 98 patients with hepatolenticular degeneration and cirrhosis admitted to Anhui Provincial Hospital of Traditional Chinese Medicine from June 2022 to July 2023 were selected as the observation group. The Child-Pugh score was calculated and divided into three subgroups: A, B and C according to its classification. A total of 98 cases of physical examination in the hospital during the same period were selected as the control group. The electrocardiogram parameters of the two groups were collected and compared to explore the correlation between Child-Pugh classification and electrocardiogram variation in WD patients. Results (1) The abnormal rate of electrocardiogram in the observation group (84.69%) was higher than that in the control group (25.51%), and the difference was statistically significant (P < 0.05). (2) Compared with the control group [(68.11±3.95) times/min, (91.09±4.55) ms], the heart rate and QRS duration of the observation group [(75.57±6.56) times/min, (102.23±7.98) ms] were prolonged, and the difference was statistically significant (P < 0.01). (3) Compared with subgroup A, the heart rate of subgroup B and subgroup C was accelerated, the QRS duration, QT and QTc interval were prolonged, and the difference was statistically significant (P < 0.01). (4) Spearman correlation analysis showed that Child-Pugh classification was positively correlated with heart rate (r=0.740, P < 0.001), QRS duration (r=0.495, P < 0.001), QT interval (r=0.442, P < 0.001), QTc interval (r=0.490, P < 0.001), and negatively correlated with P-R interval (r=-0.433, P < 0.001). Conclusion Patients with hepatolenticular degeneration and cirrhosis are more likely to have non-specific ECG abnormalities than normal people. There is a certain relationship between the severity of liver cirrhosis and its electrocardiogram variability. -
Key words:
- Wilson ' s disease /
- Liver cirrhosis /
- Child-Pugh classification /
- Electrocardiogram
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表 1 观察组与健康对照组一般资料比较
Table 1. Comparison of general data between the observation group and the healthy control group
组别 例数 性别(男性/女性，例) 年龄[M(P25, P75), 岁] BMI(x ±s) 舒张压(x ±s，mmHg) 收缩压(x ±s，mmHg) 吸烟史(是/否，例) 饮酒史(是/否，例) 糖尿病(是/否，例) 心血管疾病家族史(是/否，例) 观察组 98 50/48 33(29.5，40.3) 20.95±1.01 76.21±6.79 119.81±10.52 32/66 60/38 5/93 2/96 健康对照组 98 55/43 34(26.0，40.0) 20.92±1.06 76.86±5.64 120.38±9.51 28/70 58/40 11/87 4/94 统计量 0.513a -0.799b 0.225c 0.721c -0.399c 0.384a 0.085a 2.450a 0.688a P值 0.474 0.424 0.822 0.472 0.690 0.535 0.770 0.118 0.407 注：a为χ2值，b为Z值，c为t值。1 mmHg=0.133 kPa。 
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表 2 观察组和健康对照组ECG异常率比较[例(%)]
Table 2. Comparison of ECG abnormality rates between the observation group and the healthy control group[cases (%)]
组别 例数 正常心电图 异常心电图 健康对照组 98 73(74.49) 25(25.51) 观察组 98 15(15.31) 83(84.69) χ2值 69.375 P值 ＜0.001
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表 3 观察组和健康对照组ECG参数比较(x ±s)
Table 3. Comparison of ECG parameters between the observation group and the healthy control group(x ±s)
组别 例数 HR(次/min) P波(ms) QRS时限(ms) P-R(ms) QT间期(ms) QTc间期(ms) RV5(mV) SV1(mV) 观察组 98 75.57±6.56 100.91±2.60 102.23±7.98 130.42±22.18 344.45±12.53 390.98±20.54 1.40±0.50 1.20±0.20 健康对照组 98 68.11±3.95 101.08±2.50 91.09±4.55 149.62±18.93 337.73±8.60 384.07±15.61 2.00±0.37 1.15±0.26 t值 9.647 0.476 12.006 -6.520 4.268 2.650 9.576 1.569 P值 ＜0.001 0.634 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 0.118
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表 4 不同Child-Pugh分级各组肝豆状核变性合并肝硬化患者ECG参数比较(x ±s)
Table 4. Comparison of ECG parameters of patients with hepatolenticular degeneration combined with liver cirrhosis in different groups with different Child endoscopic Pugh grades(x ±s)
Child-Pugh分级 例数 HR(次/min) P波(ms) QRS时限(ms) P-R(ms) QT(ms) QTc(ms) RV5(mV) SV1(mV) A级 36 70.06±5.00ab 101.22±2.53 98.00±6.21ab 141.47±25.58b 338.06±8.48ab 380.19±13.66ab 1.39±0.56 1.21±0.21 B级 34 76.06±4.60b 100.53±2.74 101.97±5.80b 129.88±19.46b 344.74±10.99 390.62±16.58b 1.35±0.47 1.17±0.18 C级 28 82.07±3.40 100.96±2.55 107.93±8.998 117.21±13.43 351.96±15.00 405.29±23.90 1.48±0.45 1.22±0.22 F值 57.595 0.625 15.744 10.959 11.536 15.202 0.501 0.793 P值 ＜0.001 0.543 ＜0.001 ＜0.001 ＜0.001 ＜0.001 0.612 0.464 注：与B级比较，aP＜0.05;与C级比较，bP＜0.05。
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表 5 Child-Pugh分级与心电图参数的相关性
Table 5. Correlation between Child-Pugh grade and ECG indicators
项目 rs值 P值 HR(次/min) 0.740 ＜0.001 P波(ms) -0.048 0.641 QRS时限(ms) 0.495 ＜0.001 P-R(ms) -0.433 ＜0.001 QT(ms) 0.442 ＜0.001 QTc(ms) 0.490 ＜0.001 RV5(mV) 0.067 0.513 SV1(mV) 0.010 0.919
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