STEMI患者溶栓前后Tp-ec、Tp-e/QT值变化和意义探讨  

Changes and prognostic values of Tp-ec and Tp-e/QT ratio in patients undergoing thrombolysis due to acute myocardial infarction

作　　者：杨曙艳[1] 王宪沛[2] 肖文涛[2] 晏娟娟[2] 李牧蔚[2] 张优[3] 刘静静[2] 戴国友[2] 胡大一[3] 高传玉[2] 

机构地区：[1]河南省胸科医院,郑州450002 [2]郑州大学人民医院心内科 [3]郑州大学人民医院流行病学中心

出　　处：《临床心血管病杂志》2014年第10期857-860,共4页Journal of Clinical Cardiology

基　　金：河南省科技攻关课题(No:132102310080))

摘　　要：目的:比较急性ST段抬高型心肌梗死(STEMI)患者成功溶栓前后不同时期校正QT间期(QTc)、校正Tp-e间期(Tp-ec)、Tp-e/QT比值等指标的变化,分析这些指标与恶性心律失常事件(MAE)的相关性,探讨其临床预测价值。方法:连续收集STEMI患者213例,其中瑞替普酶溶栓76例(36%),临床判断再通57例(75%)为试验组。试验组患者在2周内均进行了冠状动脉(冠脉)造影和支架植入治疗,分别测算溶栓前、溶栓后(7±1)d和(30±3)d梗死相关和非梗死相关导联QTc、Tp-ec、Tp-e/QT比值,并进行比较;随访1个月内MAE情况。另以60例冠脉造影正常者为对照组。结果:1溶栓前试验组梗死相关和非梗死相关导联QTc、Tp-ec和Tp-e/QT较对照组均增大(均P<0.05),且在梗死和非梗死相关导联间均差异有统计学意义(均P<0.05);溶栓后1周QTc在梗死和非梗死相关导联即回落至正常水平,溶栓后1周、1个月时Tp-ec和Tp-e/QT较前一期相同导联显著减小(P<0.05),且在梗死和非梗死相关导联间均差异有统计学意义(均P<0.05),仅Tp-ec溶栓后1个月时在非梗死相关导联回复正常。2试验组以溶栓前梗死相关导联QTc 440ms作为节点分组,1个月内组间MAE发生差异无统计学意义,分别以溶栓前梗死相关导联Tp-ec 100ms和Tp-e/QT比值0.25作为节点分组,1个月组间MAE发生差异均有统计学意义(均P<0.05)。结论:STEMI患者溶栓前Tp-ec、Tp-e/QT比值的变化与1个月MAE的发生相关。Objective：To explore the prognostic value of corrected QT interval（QTc）,corrected Tp-e interval（Tp-ec）and Tp-e/QT ratio on occurrence of malignant arrhythmia events（MAE）in acute ST-segment elevation myocardial infarction（STEMI）patients underwent successful thrombolysis.Method：Seventy-six cases of 213 consecutive STEMI received thrombolytic treatment with Reteplase（rPA）.Fifty-seven of 76patients（observation group）thrombolysed with Reteplase（rPA）were successful according to clinical criteria and had successful PCI in two weeks.QTc,Tp-ec and Tp-e/QT ratio were obtained and calculated in infarct-related ECG leads and non-infarct-related leads before thrombolysis,（7±1）days and（30±3）days respectively,and MAEs were recorded in one month.Result：①QTc,Tp-ec,Tp-e/QT in infarct-related and non-infarct-related leads in observation group increased significantly before thrombolysis compared with those in control group（P〈0.05）,and there had significant difference between the infarct-related and non-infarct-related leads（P〈0.05）.QTc in infarct-related and noninfarct-related leads returned to normal level in one week after thrombolysis（P〉0.05）;while in one week and one month after thrombolysis,Tp-ec、Tp-e/QT decreased markedly compared with those in the same leads before（P〈0.05）,and there had significant difference between the infarct-related and non-infarct-related leads（P〈0.05）,except Tp-ec in non-infarct-related leads recovered to normal level in one month after thrombolysis.②The occurrence of MAE had no difference between two groups of QTc cutoff as 440 ms before thrombolysis in infarct-related leads.While the occurrence of MAE had significant difference（P〈0.05）with a cutoff of Tp-ec as 100 ms and that of Tp-e/QT ratio as 0.25 before thrombolysis in infarct-related leads,respectively.Conclusion：Changes of Tp-ec,Tp-e/QT before thrombolysis in patients with STEMI are related with MAE occurrence of one month,which are possibly the new indicator

关 键 词：心肌梗死 心电描记术 血栓溶解疗法 临床预后 

分 类 号：R542.2[医药卫生—心血管疾病]