碎裂QRS波联合红细胞分布宽度对陈旧性心肌梗死患者主要不良心血管事件的预测价值  

Value of fragmented QRS complex combined with red blood cell distribution width in predicting major adverse cardiovascular events in patients with old myocardial infarction

作　　者：赵新悦 李元民 肖强 郭慧梅 ZHAO Xinyue;LI Yuanmin;XIAO Qiang;GUO Huimei(Department of Cardiology,the Second Affiliated Hospital of Shandong First Medical University,Taian Shandong 271000,China)

机构地区：[1]山东第一医科大学第二附属医院心内科,山东泰安2710001

出　　处：《实用心电学杂志》2024年第3期250-257,263,共9页Journal of Practical Electrocardiology

基　　金：泰安市科技局资助项目(2018NS0145)。

摘　　要：目的探讨碎裂QRS波(fragmented QRS complex,fQRS)、红细胞分布宽度(red blood cell distribution width,RDW)及两者联合对陈旧性心肌梗死患者(old myocardial infarction,OMI)主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法回顾性分析530例OMI患者的临床资料,根据有无fQRS分为fQRS阳性组和fQRS阴性组。采用Logistic回归分析fQRS阳性的影响因素。根据随访期间是否发生MACE,将这些患者分为MACE组和非MACE组,并通过多因素Logistic回归分析OMI患者发生MACE的独立危险因素。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线),分析fQRS、RDW对OMI患者发生MACE的预测效能。结果多因素Logistic回归分析显示,高RDW(OR=2.757,95%CI 1.961~3.877,P<0.05)的患者更容易出现fQRS;fQRS阳性(OR=2.719,95%CI1.619~4.566)、合并高血压(OR=2.147,95%CI 1.212~3.803)、左心房内径(OR=1.100,95%CI 1.039~1.164)、RDW升高(OR=1.909,95%CI 1.463~2.575)、左心室射血分数(LVEF)降低(OR=0.933,95%CI 0.894~0.973)、Gensini评分升高(OR=1.038,95%CI 1.024~1.053)、丙氨酸转氨酶升高(OR=0.998,95%CI 1.002~1.027)是OMI患者发生MACE的独立危险因素(P均<0.05)。ROC曲线分析显示,fQRS对心力衰竭、再发心绞痛、靶血管血运障碍、恶性心律失常、心源性死亡有预测价值(P均<0.05),AUC分别为0.617、0.682、0.696、0.652、0.672。RDW对再发心绞痛、靶血管血运障碍、恶性心律失常、心源性死亡有预测价值(P均<0.05),AUC分别为0.717、0.804、0.673、0.809。fQRS,RDW,LVEF,fQRS联合RDW,RDW联合LVEF,fQRS联合LVEF,三者联合预测MACE的AUC分别为0.687、0.729、0.670、0.756、0.778、0.762、0.798。结论RDW是fQRS阳性的影响因素,RDW越高的OMI患者fQRS阳性率越高。fQRS、RDW、LVEF对OMI患者MACE有较高的预测价值,两者及三者联合预测价值更高,其中,fQRS对靶血管血运障碍的预测价值更高,RDW对心源性死亡的预测价值更高。Objective To explore the value of fragmented QRS complex(fQRS),red blood cell distribution width(RDW)and their combination in predicting major adverse cardiovascular events(MACE)among patients with old myocardial infarction(OMI).Methods The clinical data of 530 patients with OMI were analyzed retrospectively.According to the presence or absence of fQRS,they were divided into fQRS positive group and fQRS negative group.The influencing factors of fQRS positive results were analyzed by Logistic regression.These patients were divided into MACE group and non-MACE group according to whether MACE had occurred during follow-up.Multivariate Logistic regression analysis was used to analyze the independent risk factors of MACE in patients with OMI.By drawing receiver operating characteristic curve(ROC curve),the predicting efficiency of fQRS and RDW on the occurrence of MACE in OMI patients was analyzed.Results Multivariate Logistic regression analysis showed that fQRS was more likely to be found in patients with high RDW(OR=2.757,95%CI 1.961-3.877,P<0.05);positive fQRS(OR=2.719,95%CI 1.619-4.566),complicated hypertension(OR=2.147,95%CI 1.212-3.803),left atrial diameter(OR=1.100,95%CI 1.039-1.164),increased RDW(OR=1.909,95%CI 1.463-2.575),decreased LVEF(OR=0.933,95%CI 0.894-0.973),increased Gensini Score(OR=1.038,95%CI 1.024-1.053),and increased ALT(OR=0.998,95%CI 1.002-1.027)were independent risk factors for MACE in patients with OMI(P<0.05).ROC curve analysis showed that fQRS had predictive value on heart failure,recurrent angina pectoris,target vessel hemodynamic disorder,malignant arrhythmias and cardiogenic death(P<0.05),with an area under curve(AUC)of 0.617,0.682,0.696,0.652 and 0.672,respectively.RDW has predictive value on recurrent angina pectoris,target vessel hemodynamic disorder,malignant arrhythmias and cardiogenic death(P<0.05),with an AUC of 0.717,0.804,0.673 and 0.809,respectively.The AUC of fQRS,RDW,LVEF,fQRS combined with RDW,RDW combined with LVEF,fQRS combined with LVEF,and the combination of the three i

关 键 词：陈旧性心肌梗死 碎裂QRS波 红细胞分布宽度 主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]