进展性Wellens综合征相关临床因素的回顾分析  

A retrospective analysis on clinical factors related to evolutionary Wellens syndrome

作　　者：程小航 王浩 Cheng Xiaohang;Wang Hao(Department of Cardiology,Beijing Royal Integrative Medicine Hospital,Beijing,102200,China;不详)

机构地区：[1]北京王府中西医结合医院心内科,北京102200

出　　处：《中国循证心血管医学杂志》2022年第4期473-475,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 探讨由Wellens综合征心电图进展至急性前壁ST段抬高型心肌梗死(STEMI)两者临床因素的特点及关系。方法 收集2014~2020年就诊于北京王府中西医结合医院心血管内科诊断为前壁STEMI患者182例,其中典型前壁STEMI患者167例分为前壁STEMI组,心电图首次诊断为Wellens综合征但进展为前壁STEMI患者15例分为Wellens进展组,收集两组性别、年龄、既往病史、心脏彩超、血脂等结果及临床不良事件资料,进行比较。结果 Wellens进展组发病年龄低于前壁STEMI组[(46.53±7.19)岁vs.(68.47±7.39)岁,P<0.01]且发病以男性居多;前壁STEMI组患者高脂血症及三酰甘油情况发生率明显高于Wellens进展组(13.3%vs.53.9%,P<0.05);心电图发现Wellens综合征心电图表现直至ST段抬高时间中位数一般在30 min以内;冠状动脉(冠脉)造影结果均为单支血管病变,TIMI血流0~1级,且无侧枝循环。结论 Wellens综合征心电图为高危心电图表现,隐匿性较高,而进展性Wellens综合征为Wellens综合征的另一种表现形式,多见于既往无冠状动脉粥样硬化性心脏病(冠心病)病史的中年男性,对此类患者应尽早行冠脉介入治疗,避免延误或加重病情。Objective To investigate the characteristics of clinical factors in electrocardiogram(ECG progression from Wellens syndrome to acute anterior ST-segment elevation myocardial infarction(STEMI) and relationship between them.Methods The patients with acute anterior STEMI(n=182) were chosen from Department of Cardiology in Beijing Royal Integrative Medicine Hospital from 2014 to 2020.The patients with typical anterior STEMI were selected into anterior STEMI group(n=167),and patients with Wellens syndrome diagnosed by ECG for the first time but progressed to anterior STEMI were selected into Wellens progress group(n=15).The materials,including gender,age,past medical history,echocardiography,blood fat and clinical adverse events,were collected and compared in 2 groups.Results The age of STEMI onset was younger in Wellens progress group than that in anterior STEMI group [(46.53±7.19) vs.(68.47±7.39),P<0.01],and most of patients were male ones in Wellens progress group(14/15).The incidence rates of hyperlipidemia and abnormal triglyceride(TG) were significantly higher in anterior STEMI group than those in Wellens progress group(13.3% vs.53.9%,P<0.05).The time median from ECG manifestations of Wellens syndrome to ST segment elevation was generally less than 30 minutes.The results of coronary angiography(CAG) all showed single-vessel lesions with TIMI flow from grade 0 to grade 1without collateral circulation.Conclusion ECG of Wellens syndrome is a high-risk ECG manifestation with higher concealment,while progressive Wellens syndrome is another manifestation of Wellens syndrome,which is more common in middle-aged men.Coronary intervention should be performed as soon as possible for such patients for avoiding delay or aggravation of the disease.

关 键 词：WELLENS综合征 急性前壁ST段抬高型心肌梗死 心电图 

分 类 号：R542.22[医药卫生—心血管疾病]