早期心电图参数预测急性心肌梗死患者恶性心律失常风险及不良预后的价值  

Value of early electrocardiogram parameters in predicting the risk of malignant arrhythmia and poor prognosis in patients with acute myocardial infarction

作　　者：侯莹 朱晓晴 王秀玲 潘青 张立君 Hou Ying;Zhu Xiaoqing;Wang Xiuling;Pan Qing;Zhang Lijun(Electrocardiogram Room,Jinan People's Hospital,Jinan 271199,China;Department of Cardiology,Jinan People's Hospital,Jinan 271199,China)

机构地区：[1]山东省济南市人民医院心电图室,271199 [2]山东省济南市人民医院心内科,271199

出　　处：《心脑血管病防治》2023年第8期17-21,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨早期心电图参数预测急性心肌梗死(AMI)患者恶性心律失常风险及不良预后的价值。方法选取2021年3月至2022年3月济南市人民医院收治的100例AMI患者为研究对象,均接受24 h动态心电图检查,根据是否发生恶性心律失常分为发生组和未发生组,比较两组一般资料、早期心电图指标,采用多因素Logistic回归模型分析影响AMI恶性心律失常发生的相关因素,绘制ROC曲线评估基于早期心电图指标对AMI恶性心律失常发生的预测效能;随访观察30 d,根据患者死亡情况分为死亡组和存活组,评估早期心电图指标对不良预后的预测价值。结果100例AMI患者中,41例发生恶性心律失常,归为发生组,其余59例未发生恶性心律失常者归为未发生组;两组血清N末端脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)水平对比差异具有统计学意义(t=2.029、2.038、2.025,P<0.05);两组Tp-Te间期、经心率校正的Tp-Te间期(Tp-Tec)、经心率校正的QT间期(QTc)、QT离散度水平及碎裂QRS波(fQRS)、右束支传导阻滞(RBBB)比例对比差异具有统计学意义(t/χ^(2)=2.047、3.538、5.101、2.006、5.017、8.212,P<0.05);多因素Logistic分析显示,Tp-Tec、QTc、fQRS波、RBBB为AMI后恶性心律失常发生的危险因素[OR(95%CI)=1.034(1.001~1.069)、1.085(1.040~1.132)、6.380(1.152~35.334)、5.376(1.013~32.474),P<0.05];ROC曲线显示,Tp-Tec、QTc、fQRS波、RBBB对AMI恶性心律失常联合预测AUC 0.846(95%CI=0.760~0.910,P<0.05);随访观察30 d,28例患者出现死亡为死亡组,其余72例为存活组,ROC曲线显示,Tp-Tec、QTc、fQRS波、RBBB对AMI预后联合预测AUC 0.892(95%CI=0.814~0.945,P<0.05)。结论AMI患者早期予以心电图监测,并关注Tp-Tec、QTc、fQRS波、RBBB心电图特征有利于预测恶性心律失常的发生,同时对预后也具有一定预测价值。Objective To investigate the value of early electrocardiogram(ECG)parameters in predicting the risk of malignant arrhythmia and poor prognosis in patients with acute myocardial infarction(AMI).Methods A total of 100 AMI patients admitted to Jinan People's Hospital from March 2021 to March 2022 were selected as the research objects.All patients underwent 24h dynamic ECG monitoring.According to the occurrence of malignant arrhythmia,they were divided into the occurrence group and the non-occurrence group.General data and early ECG parameters of the two groups were compared.Multivariate Logistic regression analysis was used to identify factors influencing the occurrence of malignant arrhythmia in AMI.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive efficacy of early ECG parameters for the occurrence of malignant arrhythmia in AMI.The patients were followed up for 30 days,and divided into the death group and the survival group based on their mortality status.The predictive value of early ECG parameters for poor prognosis was assessed.Results Among the 100 AMI patients,41 had malignant arrhythmia and were classified into the occurrence group,while the remaining 59 patients without malignant arrhythmia were classified into the non-occurrence group.There were significant differences in the serum levels of N-terminal brain natriuretic peptide precursor(NT-proBNP),creatine kinase isoenzyme(CK-MB)and troponin I(cTnI)between the two groups(t=2.029,2.038,2.025;P<0.05).Significant differences were also observed in T peak-T end(Tp-Te)interval,heart-rate corrected Tp-Te interval(Tp-Tec),heart-rate corrected QT interval(QTc),QT dispersion level,fragmented QRS(fQRS)complexes and the proportion of right bundle branch block(RBBB)between the two groups(t/χ^(2)=2.047,3.538,5.101,2.006,5.017,8.212;P<0.05).Multivariate Logistic analysis showed that Tp-Tec,QTc,fQRS complexes and RBBB were the risk factors for the occurrence of malignant arrhythmia after AMI[OR(95%CI)=1.034(1.001-1.069),1.085(1.040-1.13

关 键 词：急性心肌梗死 心电图 恶性心律失常 碎裂QRS波 

分 类 号：R542.22[医药卫生—心血管疾病]