P波离散度与TIMI危险评分对STEMI患者新发房颤的预测价值  

Usefulness of P-wave dispersion and TIMI risk score as predictors of atrial fibrillation in patients with STEMI

作　　者：张明亮[1] 张焕轶[1] 刘燕[1] 尹鲁骅[1] 吴云[1] 宋兆峰[1] 

机构地区：[1]泰安市中心医院心内科,山东省271000

出　　处：《中华临床医师杂志（电子版）》2016年第1期1-5,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：山东省自然科学基金(ZR2010HM069;ZR2014HL008)

摘　　要：目的探讨P波离散度(Pd)联合心肌梗死溶栓(TIMI)危险评分对急性ST段抬高型心肌梗死(STEMI)患者心房颤动(房颤)的预测价值。方法收集2011年3月至2014年9月在泰安市中心医院住院确诊为STEMI患者785例,根据住院7 d内是否发生房颤分为房颤组(98例)和非房颤组(687例)。采用Logistic回归及受试者工作特征(ROC)曲线分析Pd和TIMI危险评分与STEMI患者早期新发房颤的关系。结果发生房颤患者Pd与TIMI危险评分较未发生房颤患者明显升高[Pd:(45±13)ms vs.(33±10)ms,P<0.001 TIMI危险评分:8±4 vs.5±3,P<0.001]。多因素Logistic回归显示Pd与TIMI危险评分均可以独立预测STEMI患者住院7 d内房颤的发生。TIMI危险评分判定发生房颤的ROC曲线下面积要高于Pd(0.747 vs.0.708,P=0.023),将二者联合的ROC曲线下面积为0.791,均高于各自的预测值(P均<0.05)。根据ROC所计算Pd及TIMI危险评分的切点将患者分组,Pd及TIMI危险评分均增高的STEMI患者早期发生房颤的风险最大。结论临床联合应用Pd与TIMI危险评分可以预测STEMI患者新发房颤的发生。Objective The study aim was to explore the prognostic value of P-wave dispersion（Pd） and TIMI risk score for atrial fibrillation（AF） in patients with ST-segment elevation myocardial infarction（STEMI）. Methods From March 2011 to September 2014, 785 patients admitted to Taian central hospital with diagnosis of STEMI were enrolled for analysis. Patients were divided into two groups（687 patients without AF group and 98 patients with AF） according to the occurrence of AF within 7 days after hospitalization. Logistic regression and receiver operation characteristic（ROC） analyses were used to investigate the association of Pd and TIMI risk score with AF. Results Pd and TIMI risk score were significantly higher in patients with AF compared with patients without AF [Pd（45±13）ms vs.（33±10）ms, P〈0.001; TIMI risk score 8±4 vs. 5±3, P〈0.001]. Multivariable Logistic regression showed Pd and TIMI risk score were independently associated with occurrence of AF in 7 days in patients with STEMI. In receiver operating characteristic analyses, the area under the curve for TIMI risk score was higher than that of Pd（0.747 vs. 0.708, P=0.023）. The prognostic value was improved when combined these two together（0.791）. When both Pd and TIMI risk score above the optimal cut-offs defined by ROC, the highest risk of AF was observed. Conclusion The combination of Pd and TIMI risk score could predict the risk of AF in patients with STEMI.

关 键 词：ST段抬高型急性心肌梗死 P波离散度 TIMI危险评分 房颤 

分 类 号：R542.22[医药卫生—心血管疾病] R541.75[医药卫生—内科学]