2型糖尿病患者微血管并发症的严重程度和多样性与QT间期延长有关
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Severity and multiplicity of microvascular complications are associated with QT interval prolongation in patients with type 2 diabetes
背景与目的：QT间期延长在危及生命的心律失常中起着重要作用，并成为心源性猝死的危险因素。在这里，我们评估了2型糖尿病患者微血管并发症与QT间期的关系。
1
方法：纳入219位于日本东京医学院医院进行血糖控制的2型糖尿病患者。在心电图II导联上手动测量QT间期，使用Bazett公式校正心率（QTc）。分别用神经症状或跟腱反射，眼底镜检查和尿白蛋白排泄率来评估糖尿病神经病变，视网膜病变和肾病。
结果：在单因素分析中，女性性别（P = 0.025），2型糖尿病病程（P = 0.041），体重指数（P = 0.0008），收缩压（P = 0.0011）和接受胰岛素治疗（P <0.0001）与QTc呈正相关。患有三种微血管并发症之一的患者QTc较未患者延长，神经病变（P = 0.0005），视网膜病变（P = 0.0019）和肾病（P = 0.0001）。随着视网膜病变或肾病的进展，QTc延长（视网膜病变和肾病的趋势分别为P <0.001和P <0.001）。 此外，随着微血管并发症的多样性，QTc延长（趋势P <0.001）。多元回归分析显示神经病变，肾病和微血管并发症的多样性与QTc独立相关。
结论：患有严重微血管并发症的2型糖尿病患者可能存在与QT间期延长相关的高风险且危及生命的心律失常。
Shunsuke Kobayashi1, Mototsugu Nagao1* , Akira Asai1,2, et al.
Severity and multiplicity of microvascular complications are associated with QT interval prolongation in patients with type 2 diabetes.[J].
J Diabetes Investig 2017
BACKGROUND: A prolonged QT interval plays a causal role in life-threatening arrhythmia, and becomes a risk factor for sudden cardiac death. Here, we assessed the association between microvascular complications and the QT interval in patients with type 2 diabetes.
METHODS: Patients with type 2 diabetes (n = 219) admitted to Nippon Medical School Hospital (Tokyo, Japan) for glycemic control were enrolled. QT interval was measured manually in lead II on the electrocardiogram, and corrected for heart rate using Bazett’s formula (QTc). Diabetic neuropathy, retinopathy and nephropathy were assessed by neuropathic symptoms or Achilles tendon reflex, ophthalmoscopy and urinary albumin excretion, respectively.
RESULTS:In univariate analyses, female sex (P = 0.025), duration of type 2 diabetes (P = 0.041), body mass index (P = 0.0008), systolic blood pressure (P = 0.0011) and receiving insulin therapy (P < 0.0001) were positively associated with QTc. Patients with each of the three microvascular complications had longer QTc than those without: neuropathy (P = 0.0005), retinopathy (P = 0.0019) and nephropathy (P = 0.0001). As retinopathy or nephropathy progressed, QTc became longer (P < 0.001 and P < 0.001 for trend in retinopathy and nephropathy, respectively). Furthermore,QTc was prolonged with the multiplicity of the microvascular complications (P < 0.001 for trend). Multiple regression analyses showed that neuropathy, nephropathy and the multiplicity of the microvascular complications were independently associated with QTc.
CONCLUSIONS:Patients with type 2 diabetes with severe microvascular complications might be at high risk for life-threatening arrhythmia associated with QT interval prolongation.
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