心电图fQRS波及血清Serpina3、25-(OH)D_(3)对STEMI患者PCI术后ST段回落的预测价值  

Predictive value of fQRS wave and serum Serpina3,25-(OH)D_(3)for ST-segment resolution after PCI in STEMI patient

作　　者：刘芳 王涛 周晔 宋雨 赵静[2] 韩月 Liu Fang;Wang Tao;Zhou Ye;Song Yu;Zhao Jing;Han Yue(ECG Room,Fuyang Cancer Hospital,Fuyang Anhui 236000,China;Department of ECG and Cardiac Function,The First Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徽省阜阳市肿瘤医院心电图室,安徽阜阳236000 [2]安徽医科大学第一附属医院心电心功能科,合肥230000

出　　处：《保健医学研究与实践》2024年第1期49-54,共6页Health Medicine Research and Practice

基　　金：安徽省自然科学基金项目(2108085MH02143)。

摘　　要：目的探究心电图碎裂QRS(fQRS)波及血清丝氨酸蛋白酶抑制剂A3(Serpina3)、25-羟基维生素D_(3)[25-(OH)D_(3)]对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后ST段回落的预测价值,以期为临床治疗提供参考。方法选取2019年1月—2022年10月安徽省阜阳市肿瘤医院收治的200例行PCI术的STEMI患者为研究对象。PCI术后120 min根据ST段回落情况分为回落良好组(n=137)和回落不良组(n=63)。比较2组患者术前fQRS波发生率及血清Serpina3、25-(OH)D_(3)水平,通过Kappa一致性检验分析fQRS波发生率与术后ST段回落不良一致性,绘制受试者工作特征曲线(ROC曲线),探究血清Serpina3、25-(OH)D_(3)对ST段回落不良的预测价值;随访6个月,比较2组患者主要心血管不良事件(MACE)发生情况。结果回落不良组患者术前fQRS波发生率49.21%,高于回落良好组的10.22%,差异有统计学意义(P<0.05);回落不良组患者血清Serpina3水平高于回落良好组,而25-(OH)D_(3)水平低于回落良好组,差异均有统计学意义(P<0.05)。术前fQRS波发生率与PCI术后ST段回落不良一致性Kappa值为0.422;术前血清Serpina3、25-(OH)D_(3)及二者联合预测PCI术后ST段回落不良的ROC曲线下面积分别为0.689、0.867和0.887;术后6个月,回落不良组MACE总发生率22.22%,高于回落良好组的8.03%,差异有统计学意义(P<0.05)。结论STEMI患者术前心电图fQRS波与PCI术后ST段回落不良具有中度一致性,血清Serpina3、25-(OH)D_(3)水平对术后ST段回落不良预测价值较高,三者可作为STEMI患者术后ST段回落不良的早期评估指标。Objective To investigate the predictive value of fragmented QRS(fQRS)wave and serine protease inhibitor A3(SERPI-NA3),25-hydroxyvitamin D_(3)[25(OH)D_(3)]for ST-segment resolution after percutaneous coronary intervention(PCI)in ST-eleva-tion myocardial infarction(STEMI)patients,aiming to provide support for clinical treatment.Methods A total of 200 STEMI pa-tients who underwent PCI in Fuyang Cancer Hospital from January 2019 to October 2022 were selected as the study subjects.Based on the ST-segment resolution at 120 minutes after PCI,the patients were allocated to the good resolution group(n=137)and the poor resolution group(n=63).The incidence of fQRS wave and the levels of serum Serpina3 and 25-(OH)D_(3)were compared between the two groups.The consistency between the incidence of fQRS wave and poor ST-segment resolution after PCI was analyzed by the Kappa consistency test.The receiver operating characteristic(ROC)curve was plotted to explore the pre-dictive value of serum Serpina3 and 25-(OH)D_(3)for poor ST-segment resolution.The occurrence of major adverse cardiovas-cular events(MACE)was also compared between the two groups during a 6-month follow-up.Results The incidence of fQRS wave before PCI in the poor resolution group was significantly higher than that in the good resolution group(49.21%vs.10.22%;P<0.05).The level of serum Serpina3 in the poor resolution group was significantly higher than that in the good resolution group,while the level of 25-(OH)D_(3)was significantly lower than that in the good resolution group(P<0.05).The Kappa value of the consistency between the incidence of fQRS wave before PCI and poor ST-segment resolution after PCI was 0.422.The areas under the ROC curve for the prediction of poor ST-segment resolution after PCI by serum Serpina3,25-(OH)D_(3),and their combination were 0.689,0.867,and 0.887,respectively.After 6 months,the total inci-dence of MACE in the poor resolution group was significantly higher than that in the good resolution group(22.22%vs.8.03%;P<0.05).Conclusion A m

关 键 词：ST段抬高型心肌梗死 ST段回落 碎裂QRS波 丝氨酸蛋白酶抑制剂A3 25-羟基维生素D_(3) 

分 类 号：R459.7[医药卫生—急诊医学]