摘要
目的 探讨原发性肝癌患者心电图异常的危险因素及其预测预后的价值.方法 选取行经肝动脉化疗栓塞术(TACE)治疗的120例原发性肝癌患者为研究对象,根据术后7 d内心电图异常情况分为异常组(n=32)和非异常组(n=88).比较2组基线资料及24 h QT间期变异性(24 h QTV)、24 h正常心房开始除极至心室开始除极时间(R-R)间期标准差(SDNN)、24 h连续5 min正常R-R间期标准差(SDANN-index)、24 h连续5 min正常R-R间期标准差均值(SDNN-index)变化;采用二元Logistic回归模型分析原发性肝癌患者发生心电图异常的影响因素;采用受试者工作特征(ROC)曲线分析24 h QTV、SDNN、SDANN-index、SDNN-index预测原发性肝癌患者心电图异常的曲线下面积(AUC)、敏感度及特异度.结果 120例原发性肝癌患者经TACE治疗后出现心电图异常共32例,其中窦性心动过速伴T波改变13例,ST-T改变2例,室上性心动过速4例,QT间期延长4例,室性早搏4例,房性早搏5例.异常组与非异常组在性别、年龄、肝动脉超选择插管、明胶海绵栓塞、使用化疗药物、术后呕吐、术后第3天血尿酸等方面比较,差异无统计学意义(P＞0.05);2组在肿瘤直径、肝功能分级、碘油用量、术后体温、术后第3天血钾等方面比较,差异有统计学意义(P＜0.05).Logistic回归模型显示,肿瘤直径≥10 cm、肝功能分级为A级、碘油用量≥10 mL、术后体温≥38 ℃及24 h QTV、SDNN、SDANN-index、SDNN-index下降是原发性肝癌患者心电图异常的独立影响因素(P＜0.05).ROC曲线分析显示,24 h QTV、SDNN、SDANN-index、SDNN-index及心电图综合参数预测原发性肝癌患者心电图异常的AUC分别为0.682、0.651、0.632、0.752、0.786,差异有统计学意义(P＜0.05).结论 肿瘤直径、肝功能分级、碘油用量、术后体温会对原发性肝癌患者心电图产生影响,且在TACE治疗前后行心电图监测有利于及时发现心电图异常情况.
Abstract
Objective To explore the risk factors of electrocardiogram abnormalities in patients with primary liver cancer and its value in predicting prognosis.Methods A total of 120 primary liver cancer patients with transcatheter arterial chemoembolization(TACE)were selected as the research objects,and they were divided into abnormal group(n=32)and non-abnormal group(n=88)ac-cording to incidence of electrocardiogram abnormalities at 7 days after operation.Baseline data and changes in 24-hour QT interval variability(24-hour QTV),standard deviation of the normal R-R in-terval from the beginning of atrial depolarization to ventricular depolarization(SDNN),standard devia-tion of the normal R-R interval for 5 consecutive minutes(SDANN-index),and mean value of the standard deviation of the normal R-R interval for 5 consecutive minutes(SDNN-index)were compared between two groups;a binary Logistic regression model was used to analyze the influencing factors of e-lectrocardiogram abnormalities in patients with primary liver cancer;the receiver operating characteristic(ROC)curve was used to analyze the area under the curve(AUC),sensitivity and specificity of 24 h QTV,SDNN,SDANN-index and SDNN-index in predicting ECG abnormalities in patients with pri-mary liver cancer.Results Of the 120 primary liver cancer patients with TACE treatment,32 ca-ses had electrocardiogram abnormalities,including 13 cases of sinus tachycardia with T-wave chan-ges,2 cases of ST-T changes,4 cases of supraventricular tachycardia,4 cases of QT interval prolon-gation,4 cases of ventricular premature beats,and 5 cases of atrial premature beats.There were no significant differences in gender,age,super-selective hepatic artery catheterization,gelatin sponge embolization,use of chemotherapy drugs,postoperative vomiting,and blood uric acid on the third day after surgery between the abnormal group and the non-abnormal group(P＞0.05);there were significant differences in tumor diameter,liver function classification,dosage of iodized oil,postop-erative body temperature,and blood potassium on the third day after surgery between the two groups(P＜0.05).Logistic regression model showed that tumor diameter ≥10 cm,grade A of liver func-tion classification,iodized oil dose ≥10 mL,postoperative body temperature ≥38 ℃,and decrea-ses of 24 h QTV,SDNN,SDANN-index and SDNN-index were the independent factors affecting e-lectrocardiogram abnormalities in patients with primary liver cancer(P＜0.05).ROC curve analy-sis showed that the values of AUC of 24 h QTV,SDNN,SDANN-index,SDNN-index and compre-hensive electrocardiogram parameters in predicting electrocardiogram abnormalities in patients with primary liver cancer were 0.682,0.651,0.632,0.752 and 0.786 respectively,with statistically significant differences(P＜0.05).Conclusion Tumor diameter,liver function classification,dose of iodide oil and postoperative body temperature can affect electrocardiogram abnormalities in patients with primary liver cancer,and electrocardiogram monitoring before and after TACE treat-ment is conducive to timely detection of electrocardiogram abnormalities.
基金项目
江苏省南通市市级科技计划(指导性)项目(JCZ20005)
维普
万方数据