QTc-QRS间期联合主动脉夹层风险评分对A型急性主动脉夹层的预测价值  

Predictive value of QTc-QRS interval plus aortic dissection risk score in type A acute aortic dissection

作　　者：王悦童 刘北 张治[1] 王毅[1] WANG Yuetong;LIU Bei;ZHANG Zhi;WANG Yi(Department of Cardiology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)

机构地区：[1]上海交通大学附属第一人民医院心内科,上海200080

出　　处：《暨南大学学报（自然科学与医学版）》2020年第6期493-498,共6页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：国家自然科学基金项目(81470471);上海市自然科学基金(19ZR11440600);上海交通大学附属第一人民医院临床研究创新团队建设项目(CTCCR-2018C04)。

摘　　要：目的:探讨A型主动脉夹层(TAAD)和急性ST段抬高型心肌梗死(STEMI)患者心电图特征,以期发现筛查A型主动脉夹层的心电图依据.方法:回顾性分析2015年1月至2019年12月在我院确诊为TAAD的患者,以38例TAAD患者为观察组(TAAD组);以36例STEMI患者作为对照组(STEMI组),将两组的临床资料和心电图参数进行分析比较.结果:与STEMI组比较,TAAD组患者心肌复极时间(QTc-QRS)显著延长.以QTc-QRS绘制预测TAAD的受试者工作曲线,其曲线下面积为0.7,当切点值为325 ms时,QTc-QRS预测TAAD的敏感性和特异性分别为63.2%和69.4%.对QTc-QRS联合主动脉夹层风险评分(ADRS)进一步分析发现:当QTc-QRS≥325 ms且ADRS≥1,预测TAAD敏感性为47.4%,特异性为91.7%;当QTc-QRS≥325 ms且ADRS≥2,预测TAAD的敏感性为18.4%,特异性为97.2%.结论:在STEMI患者中,QTc-QRS延长可能是早期预测TAAD的一个有效指标.QTc-QRS联合ADRS,可以进一步提高对TAAD早期筛查的效能.QTc-QRS≥325 ms且ADRS≥1可作为STEMI患者中进一步筛查TAAD的依据.Objective:The ECG characteristics of patients with type A aortic dissection(TAAD)and acute ST segment elevation myocardial infarction(STEMI)were retrospectively analyzed in order to identity out the ECG basis for screening type A aortic dissection.Methods:A total of 38 patients diagnosed as TAAD in Shanghai Hospital from January 2015 to December 2019 were retrospectively included and analyzed,and the other 36 patients with ST-segment elevated myocardial infarction(STEMI)were assigned as the control group.General data and ECG parameters between two groups were compared.Results:Compared with STEMI patients,the QTc-QRS interval of TAAD was significantly prolonged.The area under the curve of ROC for QTc-QRS predicting TAAD was 0.7.When the Cut-off value of QTc-QRS was 325 ms,the sensitivity and specificity were 63.2%and 69.4%,respectively.QTc-QRS was further combined with aortic dissection risk score(ADRS),ADRS≥1 point combined with QTc-QRS≥325 ms,the sensitivity in the TAAD prediction was 47.4%,with a specificity of 91.7%.The sensitivity and specificity of ADRS≥2 combined with QTc-QRS≥325 ms in TAAD prediction were 18.4% and 97.2% respectively.Conclusion:QTc-QRS prolongation may be an effective predictor of TAAD in STEMI patients.QTc-QRS combined with ADRS analysis can further improve the efficacy of early screening of TAAD.QTc-QRS≥325 ms and ADRS≥1 can be used as the basis for further screening of TAAD in STEMI patients.

关 键 词：急性A型主动脉夹层 ST段抬高型心肌梗死 心电图 校正QT间期 主动脉夹层风险评分 

分 类 号：R540.41[医药卫生—心血管疾病]