破裂QRS波群和P波离散度及QT离散度联合血清N末端B型利钠肽原对急性心肌梗死患者并发心力衰竭的预测研究  

Predictive study of fragmentation QRS waves dispersion of P wave and QT combined with serum NT-proBNP on heart failure in patients with acute myocardial infarction

作　　者：都倩倩 都春艳 孟春[3] DU Qian-qian;DU Chun-yan;MENG Chun(ECG Room,Anqiu People’s Hospital,Weifang 262100,China;Department of Cardiology,Anqiu People’s Hospital,Weifang 262100,China;Department of Cardiology,Affiliated Hospital of Weifang Medical College,Weifang 261031,China)

机构地区：[1]安丘市人民医院心电图室,山东省潍坊市262100 [2]安丘市人民医院心内一科,山东省潍坊市262100 [3]潍坊医学院附属医院心内科

出　　处：《中国心血管病研究》2023年第12期1111-1115,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的分析碎裂QRS波群、P波离散度(Pd)及QT离散度(QTd)联合血清N末端B型利钠肽原(NT-proBNP)水平对急性心肌梗死(AMI)患者并发心力衰竭的预测价值。方法回顾性分析安丘市人民医院2019年4月至2020年7月收治的AMI患者共152例的临床资料,均于入院后检查碎裂QRS波群、Pd、QTd,检测血清NT-proBNP水平。随访6个月,统计心力衰竭发生率,比较心力衰竭发生与未发生患者上述指标;分析AMI患者并发心力衰竭的因素及各指标单独、联合对并发心力衰竭的预测价值。结果心力衰竭发生率为26.97%;年龄、吸烟史、饮酒史、合并高血压、合并2型糖尿病、合并高脂血症、多支血管病变、近端病变、心功能Ⅲ~Ⅳ级、NLR、碎裂QRS波群、Pd、QTd、血清NT-proBNP水平、发病至血运恢复时间均是AMI合并心力衰竭的危险因素(OR=4.702、3.925、3.536、3.747、3.872、4.204、4.316、4.335、4.207、4.982、4.519、6.704、6.201、6.018、4.825,P<0.05);碎裂QRS波群、Pd、QTd联合血清NT-proBNP水平预测AMI并发心力衰竭的特异度均高于单独预测(P<0.05),AUC也高于单独预测(P<0.05)。结论AMI患者有碎裂QRS波群、Pd、QTd延长、血清NT-proBNP升高现象,上述指标与年龄、吸烟史、饮酒史等均是心力衰竭发生的危险因素,且四者联合可预测心力衰竭。Objective To explore the predictive value of fragmented QRS waves,P wave dispersion(Pd)and QT dispersion(QTd)combined with serum N-terminal pro brain natriuretic peptide(NT-proBNP)level in patients with acute myocardial infarction(AMI)complicated with heart failure.Methods The clinical data of 152 patients with AMI admitted to Anqiu People’s Hospital from April 2019 to July 2020 were retrospectively analyzed.After admission,all the fragmented QRS complex,Pd,QTd and serum NT-proBNP level were detected.All the patients were followed up for 6 months,and the above indexes were compared between the patients with and without heart failure.The risk factors for heart failure in the patients with AMI and the predictive value of every index alone or combined for heart failure were analyzed.Results The incidence of heart failure was 26.97%.Age,smoking history,drinking history,hypertension,type 2 diabetes mellitus,hyperlipidemia,multivessel disease,proximal lesion,cardiac functionⅢ-Ⅳ,NLR,fragmented QRS waves,PD,QTd,serum NT-proBNP level,time from onset to recovery of blood supply were risk factors of AMI complicated with heart failure(OR=4.702,3.925,3.536,3.747,3.872,4.204,4.316,4.335,4.207,4.982,4.519,6.704,6.201,6.018,4.825,P<0.05).The specificity of fragmented QRS waves,PD and QTd combined with serum NT-proBNP level in predicting AMI complicated with heart failure were higher than those of single prediction(P<0.05),The AUC was also higher than those of single prediction(P<0.05).Conclusion The patients with AMI would have the fragmented QRS waves,prolonged Pd and QTd and elevated serum NT-proBNP,which would be,same as age,smoking history and drinking history,the risk factor for heart failure.The combination of the four would make ideal predictive effect on heart failure in the patients with AMI.

关 键 词：心电图 N末端B型利钠肽原 急性心肌梗死 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]