窦性心律震荡和碎裂QRS波结合血清cTnI及NT-proBNP预测急性心肌梗死患者介入术后短期预后不良的价值  

Value of sinus heart rate turbulence,fragmented QRS wave combined with serum cTnI and NT proBNP in predicting poor short-term prognosis after interventional therapy in patients with acute myocardial infarction

作　　者：王超[1] 韩文杰[2] WANG Chao;HAN Wen-jie(Department of Cardiac Function,Zhengzhou People's Hospital,Zhengzhou,Henan 450000,China;不详)

机构地区：[1]郑州人民医院心功能科,河南郑州450000 [2]郑州人民医院心血管内科,河南郑州450000

出　　处：《中国卫生工程学》2023年第1期35-40,共6页Chinese Journal of Public Health Engineering

摘　　要：目的探讨窦性心律震荡、碎裂QRS波(fQRS)结合血清心肌肌钙蛋白I(cTnI)、N末端B型脑钠肽前体(NT-proBNP)预测急性心肌梗死患者介入术后短期预后不良的价值。方法选取2018年9月至2021年2月本院收治的接受急诊经皮冠状动脉介入术(PCI)治疗的246例急性心肌梗死患者,均于术后48 h内行24 h动态心电图(Holter)和12导联心电图检查,记录窦性心律震荡参数震荡初始(TO)值、震荡斜率(TS)值与fQRS波出现情况,同时检测血清cTnI、NT-proBNP水平。术后随访6个月,根据预后情况将患者分为预后良好组和预后不良组。对比预后良好组和预后不良组TO值、TS值、fQRS波阳性率及血清cTnI、NT-proBNP水平,采用多因素logistic回归性分析法分析上述各指标与急性心肌梗死患者介入术后短期预后不良的关系,采用受试者工作特征(ROC)曲线分析上述各指标对急性心肌梗死患者介入术后短期预后不良的预测价值。结果术后随访期间,预后不良患者82例(预后不良组),预后良好患者164例(预后良好组)。预后不良组TO值、fQRS波阳性率及血清cTnI、NT-proBNP水平均高于预后良好组,TS值低于预后良好组,差异均有统计学意义(均P<0.05)。预后不良组性别、急性ST段抬高型心肌梗占比、病变血管支数、吸烟史、饮酒史与预后良好组比较差异均无统计学意义(均P>0.05),预后不良组年龄、冠脉Gensini评分及高血压、糖尿病、高脂血症占比均高于预后良好组,差异均有统计学意义(均P<0.05)。多因素logistic回归性分析显示,年龄、冠脉Gensini评分、合并症、TO值、fQRS波及血清cTnI、NT-proBNP水平均是急性心肌梗死介入术后短期预后不良的危险因素(OR分别为2.625、3.340、3.062、3.274、2.924、3.850、4.208,均P<0.05),TS值是保护因素(OR为0.535,P<0.05)。TO值、TS值、fQRS波及血清cTnI、NT-proBNP水平联合预测急性心肌梗死介入术后短期预后不良的灵敏度(96.34%)Objective The study was designed to investigate the value of sinus heart rate turbulence,fragmented QRS wave(fQRS)combined with serum cardiac troponin I(cTnI)and N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)in predicting poor short-term prognosis in patients with acute myocardial infarction after interventional surgery.Methods 246 patients with acute myocardial infarction treated by emergency percutaneous coronary intervention(PCI)in Zhengzhou people's hospital from September 2018 to February 2021 were selected,and were examined by 24h ambulatory electrocardiogram(Holter)and 12 lead electrocardiogram within 48 hours after operation.The turbulence onset (TO)value,oscillation turbulence(TS)value of sinus heart rate turbulence parameters and the occurrence of fQRS wave were recorded,and the levels of serum cTnI and NT-proBNP were detected.According to the 6-month follow-up after operation,the patients were divided into good prognosis group and poor prognosis group according to the prognosis.The TO value,TS value,fQRS wave positive rate and serum cTnI and NT-proBNP levels were compared between good prognosis group and poor prognosis group,and the relationships between the above indexes and the poor short-term prognosis after interventional surgery in patients with acute myocardial infarction were analyzed by multivariate logistic regression analysis method,and the predictive values of the above indexes for the poor short-term prognosis of patients with acute myocardial infarction after interventional surgery were analyzed by receiver operating characteristic(ROC)curve.Results During the 6-month follow-up after operation,the poor prognosis rate was 33.33%(82/246).The TO value,positive rate of fQRS wave and the levels of serum cTnI and NT-roBNP in the poor prognosis group were higher than those in the good prognosis group(P<0.05),while the TS value was lower than that in the good prognosis group(P<0.05).Multivariate logistic regression analysis showed that age,coronary Gensini score,complication(hype

关 键 词：窦性心律震荡 碎裂QRS波 心肌肌钙蛋白I N末端B型脑钠肽前体 急性心肌梗死 预测价值 

分 类 号：R541.4[医药卫生—心血管疾病] R542.2[医药卫生—内科学]