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慢性丙型肝炎后肝硬化患者心电图改变与Child-Pugh分级相关性

作者：胡俊华李儒贵谭华炳

单位：湖北医药学院附属人民医院感染性疾病科肝病研究所湖北十堰 442000

关键词：CHC 肝硬化心电图肝硬化性心肌病 Child-Pugh分级

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出版年,卷(期):页码：2015,7(2):45-48

摘要：

摘要：目的探讨慢性丙型肝炎（CHC）后肝硬化患者心电图改变与Child-Pugh分级和肝硬化性心肌病（CCM）之间的关系。方法设立健康对照组（51例）、CHC组（45例）、CHC后肝硬化组（51例）。CHC后肝硬化组按照Child-Pugh分级标准又分为Child-Pugh A级14例，Child-Pugh B级20例，Child-Pugh C级17例。所有病例使用日本光电心电图机 ECG-1550P标准12导联同步心电图机记录、测量、分析心电图，比较各组心电图改变的差异及与Child-Pugh分级和CCM发病的关系。结果 ①心电图异常：CHC后肝硬化组心电图异常率为72.55%，总心电图异常例次112，平均每例患者有2.20次异常心电图；健康对照组、CHC组心电图异常率分别为1.96%、6.66%，均为轻微异常心电图。②CHC后肝硬化主要心电图异常种类：Q-T间期延长（28/51，54.90%），ST-T改变（27/51，52.94%），肢导低电压（17/51，33.33%），说明3种异常心电图组合较为常见。③CHC后肝硬化组患者心电图异常组合与Child-Pugh分级之间的关系：Child-Pugh A级Q-Tc间期延长0例（0/14），ST-T改变1例（1/14），肢导低电压1例（1/14）；Child-Pugh B级Q-Tc间期延长13例（13/20），ST-T改变11例（11/20），肢导低电压5例（5/20）；Child-Pugh C级Q-T间期延长15（15/17），ST-T改变15例（15/17），肢导低电压11例（11/17）。结论 CHC后肝硬化患者存在多种心电图异常，其中以Q-Tc间期延长、ST-T改变、肢导低电压为主，出现3种心电图异常组合且肝功能为Child-Pugh B级、Child-Pugh C级，且并发CCM，对判断CHC后肝硬化预后具有重要提示作用。

Abstract: Objective To investigate the correlationship between electrocardiographic abnormality and Child-Pugh classification and cirrhotic cardiomyopathy (ECM) in patients with liver cirrhosis caused by chronic hepatitis C (CHC). Mehtods Patients were divided into CHC group (45 cases) and liver cirrhosis
caused by CHC group (51 cases), and 51 healthy cases were taken as normal control. According to Child- Pugh classification, 51 patients confirmed as cirrhosis were classified into liver function grade A (17 cases), liver function grade B (20 cases), and liver function grade C (17 cases). All cases were measured with ECG- 1550P electrocardiograph tracing 12 standard leads ECG by professional staff, respectively, and data was compared. Results ⑴ The abnormal rate of ECG in liver cirrhosis caused by CHC group was 72.55%. Totally, 112 times of abnormal ECG were detected, with an average of 2.20 times. But the abnormal rates of ECG in health control group and CHC group were 1.96% and 6.66%, respectively, all with minor alterations of ECG. ⑵ There were 3 kinds of abnormal ECG findings in patients with liver cirrhosis caused by CHC: Q-Tc interval prolongation (28/51, 54.90%), abnormal ST-T in electrocardiogram (27/51, 52.94%) and limb lead low voltage (17/51, 33.33%), which always combined in various ways and occurred together in
liver cirrhosis patients caused by CHC. ⑶ The relationship between electrocardiographic abnormality andChild-Pugh classification in patients with liver cirrhosis caused by CHC: for patients of grade A, grade B and grade C according to Child-Pugh classification, the occurrence rates of Q-Tc interval prolongation, abnormal ST-T in electrocardiogram and limb lead low voltage were (0/14,13/20,15/17), (1/14,11/20,15/17) and (1/14,5/20,11/17), respectively. Conclusions CHC-related cirrhosis may lead to abnormal changes of ECG, the most important of which were Q-Tc interval prolongation, abnormal ST-T in electrocardiogram and limb lead low voltage. It was suggested that the liver function of confirmed cirrhosis is grade B or grade C according to Child-Pugh classification, and the patients may already have complications of cirrhotic cardiomyopathy. Thus, the above abnormal changes of electrocardiogram can be taken as a useful indicator for the prognosis in cirrhotic patients caused by chronic hepatitis C.

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