人类免疫缺陷病毒/获得性免疫缺陷综合征患者的心电图特征及异常率

中华传染病杂志 Pub Date : 2019-12-15 DOI:10.3760/CMA.J.ISSN.1000-6680.2019.12.006

Xiaoqing He, Yinzhong Shen, Fengru Lu, Fang Shen, Xinian Liu, Shuwen Wang

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引用次数: 0

摘要

目的分析人类免疫缺陷病毒/获得性免疫缺陷综合征(HIV/AIDS)患者的心电图特征及异常情况，为HIV/AIDS患者心血管疾病的防治提供依据。方法收集上海市公共卫生临床中心1 131例HIV/AIDS患者和5 622例非HIV/AIDS患者的心电图结果。比较两组患者心电图异常率及特点。检测HIV/AIDS患者CD4+ T淋巴细胞计数、CD8+ T淋巴细胞计数及CD4/CD8比值。两组比较采用卡方检验。采用Logistic回归模型探讨HIV/AIDS患者心电图异常的相关因素。结果1 131例HIV/AIDS患者中心电图异常611例(54.02%)。常见异常心电图类型为窦性心动过速239例(39.12%)，窦性心律伴ST-T改变115例(18.82%)，窦性心动过缓55例(9.00%)。5 622例非hiv /AIDS患者中心电图异常1 958例(34.83%)。常见的心电图异常类型为窦性心动过缓633例(32.33%)，窦性心律伴ST-T改变463例(23.65%)，窦性心律失常256例(13.07%)。HIV/AIDS患者心电图异常率显著高于非HIV/AIDS患者(χ2=140.39, P<0.01)。<50岁、≥50岁HIV/AIDS患者心电图异常率均高于相应年龄组非HIV/AIDS患者，差异有统计学意义(χ2分别=111.92、52.12,P均<0.01)。Logistic回归分析显示，与非hiv /AIDS人群相比，hiv感染者发生ECG异常的风险增加(优势比(OR)=2.27, 95%可信区间(CI) 2.00 ~ 2.60, P<0.01)。≥50岁患者发生心电图异常的风险增加(OR=1.60, 95%CI 1.45 ~ 1.77, P<0.01)。不同水平HIV/AIDS患者CD4+ T淋巴细胞计数、CD8+ T淋巴细胞计数及CD4/CD8比值的心电图异常分布模式差异有统计学意义(χ2分别= 12.92、10.99、16.48,P均<0.05)。≥50岁的HIV/AIDS患者出现心电图异常的风险增加(OR=1.50, 95%CI 1.15 ~ 1.96, P<0.01)。当CD8+ T淋巴细胞计数≥500/μL时，心电图异常风险降低(OR=0.75, 95%CI 0.58 ~ 0.96, P<0.01)。结论HIV/AIDS患者心电图异常率高。窦性心动过速和窦性心律伴ST-T段改变是常见的。≥50岁时，HIV/AIDS患者发生心电图异常的风险增加，CD8+ T细胞计数≥500/μL时，心电图异常的风险降低。心电图异常的类型分布与患者的细胞免疫状态有关。关键词:心电图;人类免疫缺陷病毒;获得性免疫缺陷综合征;影响因素;CD4淋巴细胞计数;CD8淋巴细胞计数

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Characteristics and abnormal rate of electrocardiogram in patients with human immunodeficiency virus/acquired immunodeficiency syndrome

Objective To analyze the characteristics and abnormalities of electrocardiograms (ECG) in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and to provide evidences for the prevention and treatment of cardiovascular diseases in HIV/AIDS patients. Methods The ECG results of 1 131 HIV/AIDS patients and 5 622 non-HIV/AIDS subjects from Shanghai Public Health Clinical Center were involved. The abnormality rates and characteristics of ECG were compared between the two groups. CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios were measured in HIV/AIDS patients. The comparison between two groups was conducted by chi-square test. Logistic regression model was used to explore the factors associated with ECG abnormalities in HIV/AIDS patients. Results There were 611 cases (54.02%) out of 1 131 HIV/AIDS patients with abnormal ECG. The common abnormal ECG types were sinus tachycardia 239 cases (39.12%), sinus rhythm with ST-T changes 115 cases (18.82%) and sinus bradycardia 55 cases (9.00%). There were 1 958 cases (34.83%) out of 5 622 cases of non-HIV/AIDS subjects with abnormal ECG. The common ECG abnormality types were sinus bradycardia 633 cases (32.33%), sinus rhythm with ST-T changes 463 cases (23.65%) and sinus arrhythmia 256 cases (13.07%). The abnormal rate of ECG in HIV/AIDS patients was significantly higher than that in non-HIV/AIDS subjects (χ2=140.39, P<0.01). The abnormal rates of ECG in HIV/AIDS patients <50 years old and ≥50 years old were both higher than those of non-HIV/AIDS subjects in the corresponding age group, and the differences were statistically significant (χ2=111.92 and 52.12, respectively, both P<0.01). Logistic regression analysis showed an increased risk of abnormal ECG in HIV-infected individuals compared with non-HIV/AIDS individuals (odds ratio (OR)=2.27, 95% confidence interval (CI) 2.00-2.60, P<0.01). The risk of ECG abnormality increased in patients aged ≥50 years(OR=1.60, 95%CI 1.45-1.77, P<0.01). The ECG abnormal distribution patterns were significantly different between different levels of CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios in HIV/AIDS patients (χ2= 12.92, 10.99 and 16.48, respectively, all P<0.05 ). The risk of ECG abnormality increased in HIV/AIDS patients aged ≥50 years (OR=1.50, 95%CI 1.15-1.96, P<0.01). When CD8+ T lymphocyte counts ≥500/μL, the risk of ECG abnormalities reduced (OR=0.75, 95%CI 0.58-0.96, P<0.01). Conclusions The abnormal rate of ECG in patients with HIV/AIDS is high. The sinus tachycardia and sinus rhythm with ST-T segment changes are common. The risk of ECG abnormality increases in HIV/AIDS patients aged ≥50 years old and reduces when the CD8+ T lymphocyte counts ≥500/μL. Type distribution of ECG abnormalities is associated with cellular immune status of patients. Key words: Electrocardiography; Human immunodeficiency virus; Acquired immunodeficiency syndrome; Influencing factors; CD4 lymphocyte count; CD8 lymphocyte count

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来源期刊

中华传染病杂志

自引率

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发文量

5280

期刊介绍： The Chinese Journal of Infectious Diseases was founded in February 1983. It is an academic journal on infectious diseases supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by the Shanghai Medical Association. The journal targets infectious disease physicians as its main readers, taking into account physicians of other interdisciplinary disciplines, and timely reports on leading scientific research results and clinical diagnosis and treatment experience in the field of infectious diseases, as well as basic theoretical research that has a guiding role in the clinical practice of infectious diseases and is closely integrated with the actual clinical practice of infectious diseases. Columns include reviews (including editor-in-chief reviews), expert lectures, consensus and guidelines (including interpretations), monographs, short monographs, academic debates, epidemic news, international dynamics, case reports, reviews, lectures, meeting minutes, etc.