QTc、Tp-Tec间期联合血清CTRP9水平对急性心肌梗死后室性心律失常发生的预测价值  

Predictive value of QTc and Tp-Tec intervals combined with serum CTRP9 levels for the development of ventricular arrhythmias after acute myocardial infarction

作　　者：朱明辉 杨磊[2] 殷珺妹[3] 张磊[4] 刘迎午[1] ZHU Minghui;YANG Lei;YIN Junmei;ZHANG Lei;LIU Yingwu(Department of Cardiology,Tianjin Third Central Hospital,Tianjin 300170,China;不详)

机构地区：[1]天津市第三中心医院心脏内科,天津300170 [2]天津市第三中心医院心功能室 [3]天津市第三中心医院医学统计室 [4]天津市第三中心医院检验科

出　　处：《山东医药》2022年第13期24-28,共5页Shandong Medical Journal

基　　金：天津市卫生健康科技项目(KJ20114)。

摘　　要：目的探讨按心率校正的QT(QTc)、按心率校正的Tp-Te(Tp-Tec)间期联合血清补体1q/肿瘤坏死因子相关蛋白9(CTRP9)水平对急性心肌梗死(AMI)后室性心律失常(VA)发生的预测价值。方法选择AMI患者156例,住院期间发生VA 61例(VA组)、未发生VA 95例(non-VA组)。入院时先行常规心电图检查,然后接受24 h动态心电图监测,记录QT、Tp-Te间期,计算QTc、Tp-Tec间期;入院次日,采集清晨空腹肘静脉血,离心留取血清,采用ELISA法检测血清CTRP9。比较两组一般临床资料[包括性别、年龄、BMI、吸烟史、基础疾病(高血压、糖尿病、高脂血症)]、疾病相关资料[包括入院时Killip分级、入院后6 h内左室射血分数(LVEF)]、实验室检查资料[包括入院次日血脂(TC、TG、HDL-C、LDL-C)、血肌酐(Scr)、血尿酸(UA)、空腹血糖(FPG)以及血清CTRP9水平]、心电图检查资料(包括QTc、Tp-Tec间期),采用多因素Logistic回归模型分析AMI后VA发生的影响因素。采用受试者工作特征(ROC)曲线分析QTc、Tp-Tec间期和血清CTRP9水平对AMI后VA发生的预测价值。结果与non-VA组比较,VA组QTc、Tp-Tec间期明显延长,血清CTRP9水平明显降低(P均<0.05)。两组一般临床资料和血脂、FPG、Scr比较P均>0.05;VA组Killip分级>Ⅱ级比例高于non-VA组,而LVEF低于non-VA组(P均<0.05);VA组UA高于non-VA组(P<0.05)。多因素Logistic回归分析显示,UA和QTc、Tp-Tec间期均为AMI后VA发生的独立危险因素,而CTRP9则为其独立保护因素(P均<0.05)。ROC曲线分析显示,QTc、Tp-Tec间期联合血清CTRP9水平预测AMI后VA发生的曲线下面积(AUC)明显高于QTc间期、Tp-Tec间期、QTc间期+Tp-Tec间期、血清CTRP9水平预测AMI后VA发生的AUC(P均<0.01)。结论AMI后VA患者QTc、Tp-Tec间期明显延长,血清CTRP9水平明显降低;QTc、Tp-Tec间期是AMI后VA发生的独立危险因素,而CTRP9则为其独立保护因素;QTc、Tp-Tec间期和血清CTRP9水平对AMI后VA发生均具有一定预测价Objective To investigate the predictive value of heart rate-corrected QT(QTc)and heart rate-corrected Tp-Te(Tp-Tec)intervals combined with serum complement 1q/tumor necrosis factor-related protein 9(CTRP9)levels for the development of ventricular arrhythmias(VA)after acute myocardial infarction(AMI).Methods A total of 156 patients with AMI were selected,VA occurred in 61 cases during hospitalization(VA group),and 95 cases(non-VA group)did not have VA.The QT and Tp-Te intervals were recorded on admission using a 12-lead ECG machine,and the QTc and Tp-Tec intervals were calculated.On the next day of admission,early morning fasting elbow venous blood was collected,centrifuged and serum was retained,and serum CTRP9 was measured by ELISA.We compared the general clinical data[including gender,age,BMI,smoking history,underlying diseases(hypertension,diabetes,hyperlipidemia)],disease-related data[including Killip classification on admission,left ventricular ejection fraction(LVEF)within 6 h after admission],laboratory examination data[including the four lipid items(TC,TG,HDL-C,LDL-C),blood creatinine(Scr),blood uric acid(UA),fasting plasma glucose(FPG)and serum CTRP9 level on the day after admission]and ECG examination data(including QTc,Tp-Tec interval)between the two groups.A multi-factor Logistic regression model was used to analyze the factors influencing the development of VA after AMI.Receiver operating characteristic(ROC)curves were used to analyze the predictive value of QTc,Tp-Tec intervals and serum CTRP9 levels in the development of VA after AMI.Results Compared with the non-VA group,the QTc and Tp-Tec intervals were significantly prolonged and serum CTRP9 levels were significantly lower in the VA group(all P<0.05).No significant differences were found in the general clinical data and blood lipid,FPG,or Scr between the two groups(all P>0.05).The ratio of Killip grade>Ⅱin the VA group was higher than that in the non-VA group,while the LVEF was lower than that in the non-VA group(both P<0.05).UA was higher in

关 键 词：室性心律失常 急性心肌梗死 按心率校正的QT间期 按心率校正的Tp-Te间期 补体1q/肿瘤坏死因子相关蛋白9 

分 类 号：R541.7[医药卫生—心血管疾病] R542.2[医药卫生—内科学]