【罂粟摘要】甲状腺功能亢进患者行甲状腺手术前后Tp-e间期和Tp-e/QT比值的评估

甲状腺功能亢进患者行甲状腺手术前后Tp-e间期和Tp-e/QT比值的评估

贵州医科大学    麻醉与心脏电生理课题组

翻译：刘云琴    编辑：宋雨婷    审校：曹莹

1

背景

心室复极化是通过心电图的Tp-e间期和由心率校正的QT间期（QTc）进行评估。Tp-e/QTc的延长与心律失常和心源性死亡的风险增加有关。

2

目的

该研究为普外科和心内科门诊合作的一项单中心研究，旨在评估甲状腺手术前后甲亢患者的Tp-e间期和Tp-e/QT比值。

3

方法

共纳入65名拟行甲状腺手术的甲亢患者。在术前住院期间和甲状腺手术后6个月，对同一患者进行了心电图参数测量。在该研究中，所有受试对象皆处于窦性心律。通过12导联心电图测量Tp-e间期、Tp-e/QT和Tp-e/QTc比值。

4

结果

心率（P= 0.073）、QT间期（P= 0.432）和QTc间期（P= 0.179）在甲状腺手术前后无统计学差异。Tp-e间期（84.6±13.1比77.2±10.9；P=0.031）、Tp-e/QT比值（0.23±0.04比0.21±0.04；P<0.001）、Tp-e/QTc比值（0.21±0.04比0.19±0.03；P<0.001）和QTc离散度（52.4±7.2比48.4±7. 4；P<0.001）在甲状腺手术前后有明显差异。在相关分析中，甲亢患者术前Tp-e/QTc比值与术前FT₄之间存在明显的相关性（r=0.275, P=0.026）。

5

结论

本研究表明，甲亢患者在甲状腺手术术后Tp-e间期、Tp-e/QT和Tp-e/QTc比值比术前小。本研究表明，甲状腺功能亢进可能对心脏传导系统产生负面影响，有可能诱发室性心律失常的发生。

原始文献来源：

Aydin A, Gayretli Yayla K. The assessment of Tp-e interval and Tp-e/QT ratio in patients with hyperthyroidism before and after thyroid surgery. Int J Clin Pract. 2021;75(12):e14937.

英文原文

The assessment of Tp-e interval and Tp-e/QT ratio in patients with hyperthyroidism before and after thyroid surgery

Background: Ventricular repolarisation is assessed using the Tp-e interval  and QT interval corrected by the heart rate (QTc) via an electrocardiogram (ECG). Prolonged Tp-e/QTc is related with an increased risk of arrhythmias and cardiac mortality.

Objective: This study was conducted at a single centre in collaboration with general surgery and cardiology clinics. We aimed to appraise the assessment of Tp-e interval and Tp-e/QT ratio in patients with hyperthyroidism before and after thyroid surgery.

Methods: Totally 65 patients with hyperthyroidism before and after thyroid surgery were enrolled in our study. In presurgical hospitalisation and six  months after the thyroid surgery, we measured the electrocardiographic  parameters again on same patients. All subjects who were investigated in  this study were in sinus rhythm. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios  were measured from the 12-lead electrocardiogram.

Results: Heart rate (P= .073), QT interval (P= .432) and QTc interval (P= .179) were similar before and after thyroid surgery. Tp-e interval (84.6 ± 13.1 vs 77.2  ± 10.9; P= .031), Tp-e/QT ratio (0.23 ± 0.04 vs 0.21 ± 0.04; P< .001), Tp-e/QTc  ratio (0.21± 0.04 vs 0.19 ± 0.03; P< .001) and QTc dispersion (52.4 ± 7.2 vs 48.4 ± 7. 4 ; P< .001) were significantly different before and after thyroid surgery. In correlation analysis, there was a significant correlation between  preprocedural Tp-e/QTc ratio and preprocedural fT4 in patients with hyperthyroidism (r = 0.275, P= .026).

Conclusion: Our study demonstrated that Tp- e interval, Tp- e/QT and Tp-  e/QTc ratios were shortened in patients with hyperthyroidism after thyroid surgery than before procedure. This study is considerable to display that  hyperthyroidism may have a negative effect on cardiac conduction system, which potentially may induce forma-tion of ventricular arrhythmias.