心电图以ST段抬高为特征的TakoSTubo心肌病与急性前壁ST段抬高型心肌梗死临床特征比较  

Comparative Study for Clinical Characteristics Between the Patients With TakoSTubo Cardiomyopathy and Acute Anterior ST-segment Elevation Myocardial Infarction

作　　者：梁滨[1] 黄榕翀[1] 康美丽[2] 史晓利 李智[4] 刘俊[1] 朱皓[1] 周旭晨[1] 

机构地区：[1]大连医科大学附属第一医院心内科,辽宁省大连市116011 [2]中国石油天然气集团公司中心医院心内科 [3]武警河南总队重症医学科 [4]大连市第三人民医院心内科

出　　处：《中国循环杂志》2015年第6期534-539,共6页Chinese Circulation Journal

基　　金：国家自然科学基金(81100220)

摘　　要：目的:分析单中心急性心肌梗死患者6年临床数据,探讨Tako STubo心肌病患者与急性心肌梗死患者临床特征的差异。方法:连续入选2008-01至2014-04在大连医科大学附属第一医院心内科住院,初步诊断为急性前壁ST段抬高型心肌梗死患者1 042例。经冠状动脉造影和左心室造影更正诊断为Tako STubo心肌病有10例患者纳入Tako STubo心肌病组。选取同一时期内发病时间≤6 h,诊断为急性前壁ST段抬高型心肌梗死,经冠状动脉造影证实为前降支单支病变的32例患者纳入前壁急性心肌梗死组。比较两组患者的基本临床特征、血脂水平、心肌标志物水平、常规12导联心电图前壁导联病理性Q波发生率、QTc间期及倒置T波分布情况。结果:在初步诊断为急性前壁ST段抬高型心肌梗死患者中,修正诊断为Tako STubo心肌病的比例为1.06%。Tako STubo心肌病组患者均为女性患者,前壁急性心肌梗死组患者中女性占9%(P<0.01)。Tako STubo心肌病组发病前存在应激史的患者比例显著高于前壁急性心肌梗死组(70%vs 22%,P=0.02),Tako STubo心肌病组患者心肌标志物峰值水平显著低于前壁急性心肌梗死组[肌酸激酶:(486.0±249.0)U/L vs(716.0±132.0)U/L,肌酸激酶同工酶:(13.5±17.1)mg/L vs(47.5±21.9)mg/L,心肌肌钙蛋白I:(22.8±16.3)ng/ml vs(56.4±24.0)ng/ml,P均<0.01]。两组间发病年龄、高血压患者比例、糖尿病患者比例、血脂水平差异均无统计学意义。两组间前壁导联Q波发生率差异无统计学意义;但Tako STubo心肌病组与前壁急性心肌梗死组在QTc间期[(630.0±117.0)ms vs(540.0±62.0)ms,P=0.001]、12导联心电图Ⅱ、Ⅲ、a VF、a VR、V6导联倒置T波发生率的差异有统计学意义(分别为100.00%vs 3.13%;60.00%vs 6.25%;90.00%vs 3.13%;100.00%vs 21.88%;100.00%vs 46.88%;P均<0.05)。结论:与急性前壁ST段抬高型心肌梗死患者相比,心电图以ST段抬高为特征的Tako STubo心肌病患者发病前多伴精神�Objective： To analyze the information of patients with acute myocardial infarction （AMI） in a single center during last 6 years, and to distinguish the clinical differences of patients between TakoSTubo cardiomyopathy （TTC） and ST-segment elevation myocardial infarction （STEMI）. Methods： A total of 1042 consecutive patients with primarily diagnosed acute anterior ST-segment elevation （STEMI） admitted in our hospital from 2008-01 to 2014-04 were retrospectively enrolled. The relevant patients were studied in 2 groups：TTC group, the patients with coronary angiography （CAG） and the contrast study of left ventricle corrected TTC diagnosis, n=10, and STEMI group, the patients received CAG within 6 hours of on set with conifrmed left anterior descending singlevessel disease at the same period of time as TTC patients,n=32. The basic clinical characteristics, levels of blood lipids, MI related biomarkers, the incidence rate of pathological Q wave, QTc interval and negative T wave in 12-lead ECG were compared between 2 groups. Results： The percentage of corrected TTC diagnosis in patients with primarily diagnosed STEMI was 1.06%. The female gender in TTC group and STEMI group was 100% vs 9%,P〈0.01, TTC group had more patients with stress history before on set than that in STEMI group （70% vs 22%,P=0.02）, lower levels of MI related biomarkers as CK （486 ± 249） U/L vs （716 ± 132） U/L, CK-MB （13.5 ± 17.1） mg/L vs （47.5 ± 21.9） mg/L, cTnI （22.8 ± 16.3） ng/mL vs （56.4 ± 24.0） ng/mL, allP〈0.01. The age of morbidity, the ratios of hypertension, diabetes mellitus and blood lipids were similar between 2 groups. The frequency of abnormal Q-wave in ECG was similar between 2 groups, while the QTc interval was different in TTC group and STEMI group （630 ± 117） ms vs （540 ± 62） ms,P=0.001, the negative T waves in ECG leads II, III, aVF, aVR and V6 were as （100.00% vs 3.13%）, （60.00% vs 6.25%）, （90.00% vs 3.13%）, （100.00% vs 21.88%）, （100.00% v

关 键 词：TakoSTubo心肌病 急性心肌梗死 前壁 心电图 

分 类 号：R54[医药卫生—心血管疾病]