含贝达喹啉方案治疗利福平耐药结核病患者QTc间期＞500ms的危险因素分析OA

Objective:To investigate the risk factors for QTc interval＞500 ms in patients with rifampicin-resistant tuberculosis(RR-TB)treated with bedaquiline(Bdq)-containing regimens,and to provide evidence for early identification of high-risk populations in clinical practice.Methods:A multicenter retrospective cohort study was conducted.Clinical data of 521 RR-TB patients treated with Bdq-containing regimens admitted to Beijing Chest Hospital Affiliated to Capital Medical University and Shaanxi Provincial Tuberculosis Prevention and Control Hospital from February 2018 to December 2025 was collected.The time from treatment initiation to the first occurrence of QTc interval＞500 ms was used as the time variable,and a single electrocardiographic measurement of QTc＞500 ms was defined as the endpoint event.Cox proportional hazards model was employed to analyze the relevant influencing factors.Results:Multivariable Cox regression analysis revealed that baseline QTc being 450-500 ms(adjusted hazard ratio(aHR)=6.640,95％confidence interval(CI):3.540-12.450),history of cardiac disease(aHR=5.840,95％CI:2.600-13.120),concurrent use of clofazimine(Cfz)(aHR=3.322,95％CI:1.247-8.855),concurrent use of delamanid(Dlm)(aHR=1.920,95％CI:1.040-3.550),triple-drug combination therapy(Bdq+Cfz+Dlm)(aHR=3.770,95％CI:1.320-10.790)were independent risk factors for QTc＞500 ms.Conclusion:Baseline QTc being 450-500 ms,prior history of cardiac disease,concurrent use of Cfz or Dlm,triple-drug combination therapy(Bdq+Cfz+Dlm)all significantly increase the risk of QTc＞500 ms in RR-TB patients.Enhanced electrocardiographic monitoring and individualized treatment strategies are recommended for these high-risk populations.