T波形态与急性心肌梗死患者经皮冠状动脉介入术后快速性心律失常发生风险的相关性  

Correlation between T wave morphology and the risk of tachyarrhythmia after percutaneous coronary intervention in patients with acute myocardial infarction

作　　者：张怡千 文惠韬 杨春蕾 ZHANG Yi-qian;WEN Hui-tao;YANG Chun-lei(Department of Critical Care Medicine,Chengdu Hospital of Integrated Traditional Chinese and Western Medicine,610000 Chengdu,China;Department of Critical Care Medicine,Chengdu Xindu District People’s Hospital,610000 Chengdu,China)

机构地区：[1]成都市中西医结合医院重症医学科,四川省成都市610000 [2]成都市新都区人民医院重症医学科

出　　处：《中国心血管病研究》2024年第7期617-622,共6页Chinese Journal of Cardiovascular Research

基　　金：2021年四川青年创新科研课题(Q21058)。

摘　　要：目的探讨T波形态与急性心肌梗死(AMI)与经皮冠状动脉介入(PCI)术快速性心律失常发生风险的相关性。方法以成都市中西医结合医院2022年4月至2024年1月收治的169例接受PCI的AMI患者为研究对象。术后48 h根据患者有无发生快速性心律失常分为发生组和未发生组。对比两组患者一般资料、实验室检查指标和T波形态相关参数。采用多因素logistic回归分析影响治疗后心律失常发生的相关因素,绘制ROC曲线并计算曲线下面积(AUC)分析T波形态和心律失常发生风险的相关性。结果入院48 h内,45例(26.63%)发生心律失常。发生组血中性粒细胞/淋巴细胞(NLR)、超敏C反应蛋白(hs-CRP)和左心室收缩末径(LVESD)高于未发生组[(4.46±1.52)比(2.78±0.82)、(2.61±0.71)mg/L比(1.94±0.41)mg/L、(40.54±3.65)mm比(38.25±5.97)mm],左心室射血分数(LVEF)低于未发生组[(45.61±5.31)%比(55.84±6.21)%](P均<0.05);发生组QT间期、Tp-Te间期、校正后Tp-Te间期(Tp-Tec)、校正后QT间期(QTc)、Tp-Te/QT高于未发生组,T波倒置发生率高于未发生组(73.33%比28.23%)(P均>0.05);多因素logistic回归分析示,hs-CRP(OR=19.495,95%CI 1.907~199.292)、NLR(OR=18.807,95%CI 3.871~91.379)、Tp-Tec(OR=1.025,95%CI 1.002~1.049)、QTc(OR=1.357,95%CI 1.096~1.680),Tp-Te/QT(OR=1.025,95%CI 1.002~1.049)、T波形态(OR=8.695,95%CI 3.267~23.139)是心律失常发生的相关因素(P<0.05)。ROC曲线显示,T波形态和心律失常发生风险的AUC为0.726(P<0.05)。结论hs-CRP、NLR、Tp-Tec、QTc,Tp-Te/QT、T波形态是心律失常发生的相关因素且T波形态和术后心律失常的发生具有较高的相关性。Objective To explore the correlation between T wave morphology and the risk of tachyarrhythmia after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods 169 AMI patients who received PCI in Chengdu Hospital of Integrated Traditional Chinese and Western Medicine from April 2022 to January 2024 were taken as the research object.48 h after operation,the patients were divided into two groups according to whether they had tachyarrhythmia or not.The general data,laboratory examination indexes and T wave morphology related parameters of the two groups were compared.Multivariate logistic regression was used to analyze the related factors affecting the occurrence of arrhythmia after the treatment.ROC curve was drawn and AUC was calculated to analyze the correlation between T wave morphology and the risk of arrhythmia.Results Within 48 hours after admission,45 cases(26.63%)developed arrhythmia.The blood neutrophil/lymphocyte(NLR),high-sensitivity C-reactive protein(hs-CRP)and left ventricular end systolic diameter(LVESD)in the occurrence group were higher than those in the non-occurrence group[(4.46±1.52)vs.(2.78±0.82)、(2.61±0.71)mg/L vs.(1.94±0.41)mg/L、(40.54±3.65)mm vs.(38.25±5.97)mm];the left ventricular ejection fraction(LVEF)in the occurrence group was lower than that in the non-occurrence group[(45.61±5.31)%vs.(55.84±6.21)%](all P<0.05).The QT interval,Tp-Te interval,corrected Tp-Te interval(TP-TEC)and corrected QT interval(QTC)in the occurrence group were higher than that in the non-occurrence group;the incidence of T-wave inversion in the occurrence group was higher than that in the non-occurrence group(73.33%vs.28.23%)(all P<0.05).Multivariate logistic regression analysis showed that hs-CRP(OR=19.495,95%CI 1.907-199.292),NLR(OR=18.807,95%CI 3.871-91.379),Tp-Tec(OR=1.025,95%CI 1.096-1.680),Tp-Te/QT(OR=1.025,95%CI 1.002-1.049)and T wave morphology(OR=8.695,95%CI 3.267-23.139)were the relative factors of arrhythmia.The ROC curve showed that the AUC of T wave mo

关 键 词：心电图 T波形态 急性心肌梗死 心律失常 相关性 

分 类 号：R541.7[医药卫生—心血管疾病]