慢性腎臓病患者における心電図所見と長期予後との関連
慢性腎臓病（CKD）患者は末期腎不全へ進展するリスクが高いことに加え，心血管疾患の発症・死亡のリスクが高い。CKD患者の予後因子に関する研究はこれまで数多くなされてきたが，心電図所見との関連を検討した研究は少ない。この研究の目的はCKD患者の予後因子を心電図所見から明らかにすることである。2009年4月から2010年3月までの12ヶ月間に当院で12誘導心電図検査と血液検査を同時期に行った16,424患者のうち，心房細動および心室性不整脈を認めた3,509患者を除き，推定糸球体濾過量が60 mL/min/1.73 m2未満であった3,325患者を対象とした。年齢，性，CKDの重症度，心電図所見（...
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| Published in | Japanese Journal of Medical Technology Vol. 67; no. 3; pp. 281 - 288 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本臨床衛生検査技師会
25.05.2018
日本臨床衛生検査技師会 Japanese Association of Medical Technologists |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0915-8669 2188-5346 |
| DOI | 10.14932/jamt.17-98 |
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| Abstract | 慢性腎臓病（CKD）患者は末期腎不全へ進展するリスクが高いことに加え，心血管疾患の発症・死亡のリスクが高い。CKD患者の予後因子に関する研究はこれまで数多くなされてきたが，心電図所見との関連を検討した研究は少ない。この研究の目的はCKD患者の予後因子を心電図所見から明らかにすることである。2009年4月から2010年3月までの12ヶ月間に当院で12誘導心電図検査と血液検査を同時期に行った16,424患者のうち，心房細動および心室性不整脈を認めた3,509患者を除き，推定糸球体濾過量が60 mL/min/1.73 m2未満であった3,325患者を対象とした。年齢，性，CKDの重症度，心電図所見（心拍数，PR間隔，QRS間隔，QTc間隔，左室肥大）と，心血管疾患・非心血管疾患による死亡と関連する因子を単変量，多変量解析で検討した。心拍数，QTc間隔，PR間隔，QRS間隔は心血管疾患死亡・非心血管疾患死亡と有意に関連した。CKD患者において心電図での心拍数 > 100 bpm，QTc間隔 ≥ 440は心血管疾患／非心血管疾患を問わず，年齢，性，CKDの重症度とは独立した長期予後不良指標である。 |
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| AbstractList | Patients diagnosed as having chronic kidney disease (CKD) are known to be at a high risk not only for progression to end-stage renal disease, but also for cardiovascular disease and sudden death. Only a few studies have shown the association between CKD and electrocardiographic (ECG) parameters. We aimed to study prognostic factors based on ECG parameters in patients with CKD. Among 16,424 patients who underwent evaluation with 12-lead ECG and blood sampling between April 2009 and March 2010, 3,325 patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 were included in this study. We excluded 3,509 patients diagnosed as having atrial fibrillation and ventricular arrhythmia. Univariate and multivariate analyses were carried out to assess the association of age, sex, severity of CKD, and ECG parameters (heart rate, PR interval, QRS interval, QTc interval, and left ventricular hypertrophy) with cardiovascular/noncardiovascular death. Heart rate > 100 bpm and a QTc interval ≥ 440 were significant markers of risk of both cardiovascular and noncardiovascular death. In patients diagnosed as having CKD, a heart rate > 100 bpm and a QTc interval ≥ 440 were factors for poor long-term prognosis independent of age, sex, and severity of CKD.
慢性腎臓病（CKD）患者は末期腎不全へ進展するリスクが高いことに加え，心血管疾患の発症・死亡のリスクが高い。CKD患者の予後因子に関する研究はこれまで数多くなされてきたが，心電図所見との関連を検討した研究は少ない。この研究の目的はCKD患者の予後因子を心電図所見から明らかにすることである。2009年4月から2010年3月までの12ヶ月間に当院で12誘導心電図検査と血液検査を同時期に行った16,424患者のうち，心房細動および心室性不整脈を認めた3,509患者を除き，推定糸球体濾過量が60 mL/min/1.73 m2未満であった3,325患者を対象とした。年齢，性，CKDの重症度，心電図所見（心拍数，PR間隔，QRS間隔，QTc間隔，左室肥大）と，心血管疾患・非心血管疾患による死亡と関連する因子を単変量，多変量解析で検討した。心拍数，QTc間隔，PR間隔，QRS間隔は心血管疾患死亡・非心血管疾患死亡と有意に関連した。CKD患者において心電図での心拍数 > 100 bpm，QTc間隔 ≥ 440は心血管疾患／非心血管疾患を問わず，年齢，性，CKDの重症度とは独立した長期予後不良指標である。 「要旨」慢性腎臓病(CKD)患者は末期腎不全へ進展するリスクが高いことに加え, 心血管疾患の発症・死亡のリスクが高い. CKD患者の予後因子に関する研究はこれまで数多くなされてきたが, 心電図所見との関連を検討した研究は少ない. この研究の目的はCKD患者の予後因子を心電図所見から明らかにすることである. 2009年4月から2010年3月までの12ヶ月間に当院で12誘導心電図検査と血液検査を同時期に行った16,424患者のうち, 心房細動および心室性不整脈を認めた3,509患者を除き, 推定糸球体濾過量が60 mL/min/1.73 m2未満であった3,325患者を対象とした. 年齢, 性, CKDの重症度, 心電図所見(心拍数, PR間隔, QRS間隔, QTc間隔, 左室肥大)と, 心血管疾患・非心血管疾患による死亡と関連する因子を単変量, 多変量解析で検討した. 心拍数, QTc間隔, PR間隔, QRS間隔は心血管疾患死亡・非心血管疾患死亡と有意に関連した. CKD患者において心電図での心拍数>100 bpm, QTc間隔≧440は心血管疾患/非心血管疾患を問わず, 年齢, 性, CKDの重症度とは独立した長期予後不良指標である. 慢性腎臓病（CKD）患者は末期腎不全へ進展するリスクが高いことに加え，心血管疾患の発症・死亡のリスクが高い。CKD患者の予後因子に関する研究はこれまで数多くなされてきたが，心電図所見との関連を検討した研究は少ない。この研究の目的はCKD患者の予後因子を心電図所見から明らかにすることである。2009年4月から2010年3月までの12ヶ月間に当院で12誘導心電図検査と血液検査を同時期に行った16,424患者のうち，心房細動および心室性不整脈を認めた3,509患者を除き，推定糸球体濾過量が60 mL/min/1.73 m2未満であった3,325患者を対象とした。年齢，性，CKDの重症度，心電図所見（心拍数，PR間隔，QRS間隔，QTc間隔，左室肥大）と，心血管疾患・非心血管疾患による死亡と関連する因子を単変量，多変量解析で検討した。心拍数，QTc間隔，PR間隔，QRS間隔は心血管疾患死亡・非心血管疾患死亡と有意に関連した。CKD患者において心電図での心拍数 > 100 bpm，QTc間隔 ≥ 440は心血管疾患／非心血管疾患を問わず，年齢，性，CKDの重症度とは独立した長期予後不良指標である。 |
| Author | 加藤, 秀樹 倉田, 貴規 栁沼, 莉絵 松浦, 菜摘 湯浅, 典博 牧, 俊哉 宮島, 悦子 |
| Author_FL | MATSUURA Natsumi YUASA Norihiro KURATA Takanori MAKI Toshiya MIYAJIMA Etsuko KATO Hideki YAGINUMA Rie |
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| References | 12) Ronald JP et al.: The Minnesota Code Manual of Electrocardiographic Findings, Standards and Procedures for Measurement and Classification, John Wright/PSG Inc, Boston, 1982. 10) Deo R et al.: “Electrocardiographic measures and prediction of cardiovascular and noncardiovascular death in CKD,” J Am Soc Nephrol, 2016; 27: 559–569. 28) Nakatani D et al.: “Incidence, predictors, and subsequent mortality risk of recurrent myocardial infarction in patients following discharge for acute myocardial infarction,” Circ J, 2013; 77: 439–446. 1) Eckardt KU et al.: “Evolving importance of kidney disease: From subspecialty to global health burden,” Lancet, 2013; 382: 158–169. 22) Desai AD et al.: “Prognostic significance of quantitative QRS duration,” Am J Med, 2006; 119: 600–606. 24) Hisamitsu T et al.: “Long-term outcomes associated with prolonged PR interval in the general Japanese population,” Int J Cardiol, 2015; 184: 291–293. 18) Purushothaman S et al.: “Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents,” J Nat Sci Biol Med, 2014; 5: 434–436. 5) D’Amico G et al.: “Pathophysiology of proteinuria,” Kidney Int, 2000; 58: 1732–1741. 13) Matsuo S et al.: “Revised equations for estimated GFR from serum creatinine in Japan,” Am J Kidney Dis, 2009; 53: 982–992. 16) Thomas F et al.: “Combined effects of heart rate and pulse pressure on cardiovascular mortality according to age,” J Hypertens, 2001; 19: 863–869. 7) Stengel B et al.: “Lifestyle factors, obesity and the risk of chronic kidney disease,” Epidemiology, 2003; 14: 479–487. 14) Keith DS et al.: “Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization,” Arch Intern Med, 2004; 164: 659–663. 23) Kestenbaum B et al.: “Kidney function, electrocardiographic findings, and cardiovascular events among older adults,” Clin J Am Soc Nephrol, 2007; 2: 501–508. 25) Badarau S et al.: “Electrocardiogram abnormalities and heart rate variability in predicting mortality and cardiovascular events among hemodialyzed patients,” Int Urol Nephrol, 2015; 47: 1703–1708. 8) Iseki K et al.: “Proteinuria and the risk of developing end-stage renal disease,” Kidney Int, 2003; 63: 1468–1474. 21) Cheng S et al.: “Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block,” JAMA, 2009; 301: 2571. 27) Kannel WB et al.: “Hypertention, antihypertensive treatment, and sudden cononary death. The Framingham Study,” Hypertention, 1988; 11: II45–II50. 4) Harnett JD et al.: “Congestive heart failure in dialysis patients: Prevalence, incidence, prognosis and risk factors,” Kidney Int, 1995; 47: 884–890. 19) Goldstein DS et al.: “The electrocardiogram in stroke: Relationship to pathophysiological type and comparison with prior tracings,” Stroke, 1979; 10: 253–259. 29) Odutayo A et al.: “Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: Systematic review and meta-analysis,” BMJ, 2016; 354: i4482. 9) Yamagata K et al.: “Risk factors for chronic kidney disease in a community-based population: A 10-year follow-up study,” Kidney Int, 2007; 71: 159–166. 3) Go AS et al.: “Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization,” N Engl J Med, 2004; 351: 1296–1305. 20) Medenwald D et al.: “QT interval, general mortality and the role of echocardiographic parameters of left ventricular hypertrophy: Results from the prospective, population-based CARLA study,” Eur J Prev Cardiol, 2016; 23: 428–436. 17) Zhang D et al.: “Resting heart rate and all-cause and cardiovascular mortality in the general population: A meta-analysis,” CMAJ, 2016; 188: E53–E63. 2) （社）日本腎臓学会（編）：CKD診療ガイド2012，東京医学社，東京，2012. 11) 日本循環器学会：「冠動脈病変の非侵襲的診断法に関するガイドライン」，Circ J, 2009; 73 Supplement III. 15) Greenland P et al.: “Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality: The Chicago Heart Association Detection Project in Industry,” Am J Epidemiol, 1999; 149: 853–862. 26) Sugimoto K et al.: “Left ventricular hypertrophy: What is the gold standard for detecting left ventricular hypertrophy? The diagnostic utility of electrocardiography,” JPN J Electocardiology, 2007; 27 Supple 2. 6) Tencer J et al.: “Diagnostic and prognostic significance of proteinuria selectivity index in glomerular diseases,” Clin Chim Acta, 2000; 297: 73–83. |
| References_xml | – reference: 23) Kestenbaum B et al.: “Kidney function, electrocardiographic findings, and cardiovascular events among older adults,” Clin J Am Soc Nephrol, 2007; 2: 501–508. – reference: 15) Greenland P et al.: “Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality: The Chicago Heart Association Detection Project in Industry,” Am J Epidemiol, 1999; 149: 853–862. – reference: 26) Sugimoto K et al.: “Left ventricular hypertrophy: What is the gold standard for detecting left ventricular hypertrophy? The diagnostic utility of electrocardiography,” JPN J Electocardiology, 2007; 27 Supple 2. – reference: 6) Tencer J et al.: “Diagnostic and prognostic significance of proteinuria selectivity index in glomerular diseases,” Clin Chim Acta, 2000; 297: 73–83. – reference: 1) Eckardt KU et al.: “Evolving importance of kidney disease: From subspecialty to global health burden,” Lancet, 2013; 382: 158–169. – reference: 21) Cheng S et al.: “Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block,” JAMA, 2009; 301: 2571. – reference: 3) Go AS et al.: “Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization,” N Engl J Med, 2004; 351: 1296–1305. – reference: 17) Zhang D et al.: “Resting heart rate and all-cause and cardiovascular mortality in the general population: A meta-analysis,” CMAJ, 2016; 188: E53–E63. – reference: 9) Yamagata K et al.: “Risk factors for chronic kidney disease in a community-based population: A 10-year follow-up study,” Kidney Int, 2007; 71: 159–166. – reference: 28) Nakatani D et al.: “Incidence, predictors, and subsequent mortality risk of recurrent myocardial infarction in patients following discharge for acute myocardial infarction,” Circ J, 2013; 77: 439–446. – reference: 22) Desai AD et al.: “Prognostic significance of quantitative QRS duration,” Am J Med, 2006; 119: 600–606. – reference: 12) Ronald JP et al.: The Minnesota Code Manual of Electrocardiographic Findings, Standards and Procedures for Measurement and Classification, John Wright/PSG Inc, Boston, 1982. – reference: 13) Matsuo S et al.: “Revised equations for estimated GFR from serum creatinine in Japan,” Am J Kidney Dis, 2009; 53: 982–992. – reference: 8) Iseki K et al.: “Proteinuria and the risk of developing end-stage renal disease,” Kidney Int, 2003; 63: 1468–1474. – reference: 4) Harnett JD et al.: “Congestive heart failure in dialysis patients: Prevalence, incidence, prognosis and risk factors,” Kidney Int, 1995; 47: 884–890. – reference: 5) D’Amico G et al.: “Pathophysiology of proteinuria,” Kidney Int, 2000; 58: 1732–1741. – reference: 2) （社）日本腎臓学会（編）：CKD診療ガイド2012，東京医学社，東京，2012. – reference: 10) Deo R et al.: “Electrocardiographic measures and prediction of cardiovascular and noncardiovascular death in CKD,” J Am Soc Nephrol, 2016; 27: 559–569. – reference: 14) Keith DS et al.: “Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization,” Arch Intern Med, 2004; 164: 659–663. – reference: 20) Medenwald D et al.: “QT interval, general mortality and the role of echocardiographic parameters of left ventricular hypertrophy: Results from the prospective, population-based CARLA study,” Eur J Prev Cardiol, 2016; 23: 428–436. – reference: 18) Purushothaman S et al.: “Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents,” J Nat Sci Biol Med, 2014; 5: 434–436. – reference: 29) Odutayo A et al.: “Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: Systematic review and meta-analysis,” BMJ, 2016; 354: i4482. – reference: 24) Hisamitsu T et al.: “Long-term outcomes associated with prolonged PR interval in the general Japanese population,” Int J Cardiol, 2015; 184: 291–293. – reference: 19) Goldstein DS et al.: “The electrocardiogram in stroke: Relationship to pathophysiological type and comparison with prior tracings,” Stroke, 1979; 10: 253–259. – reference: 27) Kannel WB et al.: “Hypertention, antihypertensive treatment, and sudden cononary death. The Framingham Study,” Hypertention, 1988; 11: II45–II50. – reference: 11) 日本循環器学会：「冠動脈病変の非侵襲的診断法に関するガイドライン」，Circ J, 2009; 73 Supplement III. – reference: 16) Thomas F et al.: “Combined effects of heart rate and pulse pressure on cardiovascular mortality according to age,” J Hypertens, 2001; 19: 863–869. – reference: 25) Badarau S et al.: “Electrocardiogram abnormalities and heart rate variability in predicting mortality and cardiovascular events among hemodialyzed patients,” Int Urol Nephrol, 2015; 47: 1703–1708. – reference: 7) Stengel B et al.: “Lifestyle factors, obesity and the risk of chronic kidney disease,” Epidemiology, 2003; 14: 479–487. |
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| Snippet | 慢性腎臓病（CKD）患者は末期腎不全へ進展するリスクが高いことに加え，心血管疾患の発症・死亡のリスクが高い。CKD患者の予後因子に関する研究はこれまで数... 「要旨」慢性腎臓病(CKD)患者は末期腎不全へ進展するリスクが高いことに加え, 心血管疾患の発症・死亡のリスクが高い. CKD患者の予後因子に関する研究はこれまで数... Patients diagnosed as having chronic kidney disease (CKD) are known to be at a high risk not only for progression to end-stage renal disease, but also for... |
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| Title | 慢性腎臓病患者における心電図所見と長期予後との関連 |
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| ispartofPNX | 医学検査, 2018/05/25, Vol.67(3), pp.281-288 |
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