碎裂QRS波与非ST段抬高型急性心肌梗死患者冠状动脉病变及左室功能的关系  

Relationship between coronary lesion and left ventricular function in patients with fragmented QRS and non-ST elevation acute myocardial infarction

作　　者：徐艳玲 余意君[1] 顾力 吴慧君 郑伟 周志云 顾晔[1] XU Yan-ling;YU Yi-jun;GU Li;WU Hui-jun;ZHENG Wei;ZHOU Zhi-yun;GU Ye(Wuhan Fourth Hospital,Puai Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430033,China)

机构地区：[1]武汉市第四医院,华中科技大学同济医学院附属普爱医院,430033

出　　处：《天津医药》2020年第5期406-410,共5页Tianjin Medical Journal

基　　金：武汉市卫计委科研资助项目(WX18Q36)。

摘　　要：目的探讨非ST段抬高型急性心肌梗死(NSTEAMI)患者碎裂QRS波(fQRS)与冠状动脉病变程度及左室功能的相关性。方法回顾性分析我院心内科住院的行冠脉造影术的NSTEAMI患者183例,根据心电图上是否存在fQRS(相邻2个及以上导联)分为nfQRS组99例和f QRS组84例。比较2组患者临床基本特征、冠脉造影资料以及超声心动图等差异。结果与nfQRS组相比,fQRS组肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、血肌酐(Scr)、超敏反应C蛋白(hs-CRP)等明显升高(P<0.05);fQRS组患者Gensini评分、N端脑利钠肽前体(NT-proBNP)值明显高于nfQRS组,LVEF明显低于nfQRS组(P<0.01)。Logistic回归分析显示,cTnI、CK-MB、Gensini评分升高以及LVEF降低是NSTEAMI患者发生fQRS的危险因素。根据f QRS出现的导联数分为2个亚组,导联数>3组的Gensini评分、冠脉病变≥3支的比例均显著高于导联数≤3组。结论心电图上存在fQRS的NSTEAMI患者,尤其是fQRS出现导联数越多者,冠脉病变更重,左室功能更差,心肌缺血更严重。ObjectiveTo investigate the relationship between the fragmented QRS(fQRS)and the degree of coronary artery lesion and left ventricular function in patients with non-ST elevation acute myocardial infarction(NSTEAMI).MethodsData of 183 patients with NSTEAMI who underwent coronary angiography in the department of cardiology of our hospital from January 2018 to October 2019 were retrospectively analyzed.According to the presence of fQRS(two or more adjacent leads)on the resting ECG,patients were divided into fQRS group(n=84)and nfQRS group(n=99).The clinical characteristics,coronary angiography data and echocardiography were analyzed between the two groups.ResultsThe blood biochemical indexes such as cTnI,CK,CK-MB,LDH,TC,TG,LDL-C,Scr and hs-CRP were significantly increased in fQRS group compared to those of nfQRS group(P<0.05).Gensini score and NT-proBNP value were significantly higher,LVEF was significantly lower,in fQRS group than those in nfQRS group(P<0.01).Logistic regression analysis showed that the higher cTnI,CK-MB and Gensini score,and the lower LVEF were risk factors for fQRS in NSTEAMI patients.The fQRS group was then divided into two subgroups.The Gensini score of the lead number>3 and the proportion of coronary artery lesion>3 were significantly higher than those with the lead number≤3 group.Conclusion For NSTEAMI patients with fQRS on the ECG,especially those with more leads of fQRS,the coronary artery lesion is more serious,the left ventricular function is worse and myocardial ischemia is more severe.

关 键 词：非ST段抬高型急性心肌梗死 碎裂QRS波 冠脉造影 GENSINI评分 左室射血分数 

分 类 号：R543.3[医药卫生—心血管疾病]