碎裂QRS波对老年陈旧性心肌梗死的诊断与预后评估价值  

Diagnostic and prognostic value of fragmented QRS complex in elderly patients with old myocardial infarction

作　　者：龙崇荣[1] 喻恒[2] 李进[1] 朱平[3] 

机构地区：[1]重庆市沙坪坝区人民医院内二科,重庆400030 [2]重庆市沙坪坝区人民医院急诊科,重庆400030 [3]第三军医大学附属西南医院心血管内科,重庆400038

出　　处：《岭南心血管病杂志》2016年第3期270-273,共4页South China Journal of Cardiovascular Diseases

基　　金：重庆市卫计委科研课题(项目编号:2012-2-347)

摘　　要：目的探讨碎裂QRS波（fragmented QRS,fQRS）对老年陈旧性心肌梗死诊断及评估预后中的临床运用价值。方法以175例老年陈旧性心肌梗死患者为研究对象,根据其心电图结果,将其分为fQRS波组和无fQRS波组,观察fQRS波对老年陈旧性心肌梗死诊断的敏感性、特异性。利用受试者工作特征曲线（receiver operating characteristic curve,ROC）分析诊断价值;比较两组主要心血管事件（major adverse cardiovascular events,MACE）发生率;通过Kaplan-Meier分析和Cox多元回归分析fQRS波与预后的关系。结果单纯fQRS波诊断老年陈旧性心肌梗死的特异性（91.4%）和阳性预测值（82.4%）均显著高于单纯病理性Q波（特异性：86.2%,阳性预测值：70.1%）。fQRS波的ROC下面积（AUC）为0.842（95%CI：0.787～0.908）,其显著高于单纯病理性Q波0.816（95%CI：0.762～0.895）。fQRS波组MACE事件发生率（22.0%）显著高于无fQRS波组（14.3%）,差异有统计学意义（P〈0.05）。Kaplan-Meier生存曲线分析显示fQRS波组生存率显著低于无fQRS波组,差异有统计学意义（P〈0.05）;Cox回归分析表明fQRS波是老年陈旧性心肌梗死全因病死率的独立预测因子,其相对危险度（RR）为2.586（95%CI：1.853～3.126）。结论 fQRS波可有效地对老年陈旧性心肌梗死进行诊断与预后评估,其可能是老年陈旧性心肌梗死全因病死率的独立危险预测因子。Objectives To study the clinical value of fragmented QRS （fQRS） in diagnosis and prognosis of elderly patients with old myocardial infarction. Methods The elderly patients with old myocardial infarction were enrolled in this study. Based on the results of electrocardiogram （EGG）, the patients were divided into fQRS group and non-fQRS group. Sensitivity and specificity of fQRS in diagnosing elderly patients with old myocardial infarction were observed and the diagostic value was analyzed by receiver operating characteristic （ROC） curve. Incidence of major adverse cardiovascular events （MACE） between the two groups was compared. Relationship between fQRS and prognosis was analyzed by Kaplan-Meier analysis and Cox regression. Results Specificity （91.4%） and positive predictive value （82.4%） of simple fQRS in diagnosing elderly patients with old myocardial infarction were significantly higher than those of pathologic Q waves （specificity： 86.2%, positive predictive value：70.1%）. Area under ROC （AUC） of fQRS was 0.842 （95% CI： 0.787-0.908）, which was significantly higher than that of pathological Q waves （0.816） （95% CI： 0.762-0.895）. Incidence rate of MACE was significantly higher in fQRS group （22.0%） than in non-fQRS group （14.3%） （P〈0.05）. Kaplan-Meier survival curve showed that the survival rate was significantly lower in fQRSgroup than in non-fQRS group （P〈0.05）. Cox regression showed that fQRS was an indepentent predictor of all-cause mortality in elderly patients with old myocardial infarction, and the relative risk （RR） was 2.586 （95% CI： 1.853- 3.126）. Conclusions FQRS can be effective in diagnosis and prognosis of elderly patients with old myocardial infarction, which may be an independent predictor of mortality in elderly patients with old myocardial infarction.

关 键 词：陈旧性心肌梗死 碎裂QRS波 老年 诊断 预后 

分 类 号：R542.22[医药卫生—心血管疾病]