心电图胸导联ΣQ/ΣR与血清脂蛋白a、ApoB/ApoA-1联合在急性ST段抬高心肌梗死患者PCI术后短期预后预测中的价值  

The Value of ECG Chest Leads ΣQ/ΣR Combined with Lp(a) and ApoB/ApoA- 1 in Predicting Short- term Prognosis after PCI in Patients with Acute ST Segment Elevation Myocardial Infarction

作　　者：姚艳影 潘兴邦 尹育华[1] 郑家华[3] YAO Yanying;PAN Xingbang;YIN Yuhua;ZHENG Jiahua(Department of Cardiovascular Medicine,Chengde Central Hospital,Chengde 067000,Hebei,China;Department of Emergency,Chuiyangliu Hospital Affiliated to Tsinghua University,Beijing 100020,China;Department of General Medicine,Chengde Central Hospital,Chengde 067000,Hebei,China)

机构地区：[1]承德市中心医院心内科,河北承德067000 [2]清华大学附属垂杨柳医院急诊科,北京100020 [3]承德市中心医院全科医学科,河北承德067000

出　　处：《中国分子心脏病学杂志》2024年第1期5869-5874,共6页Molecular Cardiology of China

基　　金：承德市科技计划项目(202006A158)。

摘　　要：目的 探讨心电图胸导联ΣQ/ΣR与血清脂蛋白a[lipoprotein a, Lp(a)]、载脂蛋白B (apolipoprotein B, ApoB)/载脂蛋白A-1(apolipoprotein A-1, ApoA-1)联合预测急性ST段抬高心肌梗死(acute ST segment elevation myocardial infarction, ASTEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后短期预后的价值。方法 选取148例接受PCI术的ASTEMI患者,均于入院时行心电图、血清Lp(a)、ApoB、ApoA-1检查。PCI术后随访30 d,根据是否发生主要心血管不良事件分为预后不良组与预后良好组。结果 预后不良组ΣQ、ΣQ/ΣR大于预后良好组,ΣR小于预后良好组,血清Lp(a)、ApoB、ApoB/ApoA-1高于预后良好组,ApoA-1低于预后良好组,且ΣQ/ΣR与Lp(a)、ApoB/ApoA-1呈正相关(P均<0.05);Cox回归分析显示,将其他混杂因素校正前后,心电图胸导联ΣQ/ΣR、血清Lp(a)、ApoB/ApoA-1均是ASTEMI患者PCI术后预后不良的独立危险因素(P均<0.05);ΣQ/ΣR、Lp(a)、ApoB/ApoA-1联合预测预后不良的曲线下面积为0.915(95%CI:0.857~0.974),大于三者单独预测。结论 心电图胸导联ΣQ/ΣR联合Lp(a)、ApoB/ApoA-1预测ASTEMI患者PCI术后短期预后的价值较高,可作为临床预测预后的潜在途径。Objective To exploring the predictive value of chest leads of electrocardiogram(ECG) ΣQ/ΣR and serum lipoprotein a [Lp(a)], apolipoprotein B(ApoB)/apolipoprotein A-1(ApoA-1) for short-term prognosis after percutaneous coronary intervention(PCI) in patients with acute ST segment elevation myocardial infarction(ASTEMI). Methods Atotal of 148 patients with ASTEMI in our hospital who underwent PCI were selected, and all the patients underwent ECG and serum Lp(a), ApoB, ApoA-1 inspection. The patients were followed up for 30 days after PCI, and divided into a poor prognosis group and a good prognosis group based on whether major adverse cardiovascular events occurred. Results The poor prognosis group ΣQ, ΣQ/ΣR were greater than the good prognosis group, ΣR was less than the good prognosis group;serum Lp(a), ApoB, ApoB/ApoA-1 were higher than the good prognosis group, and ApoA-1 was lower than the good prognosis group. And ΣQ/ΣR were positively correlated with Lp(a) and ApoB/ApoA-1(P<0.05);COX regression analysis, before and after correction for other confounding factors, ECG chest leads ΣQ/ΣR, serum Lp(a), ApoB/ApoA-1 were independent risk factors for poor prognosis after PCI in patients with ASTEMI(P<0.05). The combination of ΣQ/ΣR,Lp( a),and Apo B/Apo A-1 predicts poor prognosis with an area under curve of 0. 915( 95% CI: 0. 857-0. 974),which was greater than those predicted by the three alone. Conclusion It is suggested that the ECG chest lead ΣQ/ΣR combined with Lp( a),Apo B/Apo A-1 has a high value in predicting the short-term prognosis of patients with ASTEMI after PCI,and it can be used as a potential way to predict the prognosis.

关 键 词：急性ST段抬高心肌梗死 心电图胸导联 Q波总振幅 R波总振幅 脂蛋白 载脂蛋白 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]