急性心肌梗死溶栓前后校正QT间期、校正Tp—e间期、Tp—e／QT的变化及其预测价值

Predictive value of corrected QT interval, corrected Tp-e interval and Tp-e/QT ratio on malignant arrhythmia events in acute ST-segment elevation myocardial infarction patients undergoing thrombolysis

目的观察急性ST段抬高型心肌梗死（STEMI）患者成功溶栓前后不同时期校正QT间期（QTc）、校正TO—e间期（Tp—ec）、Tp—e／QT比值等指标的变化，分析这些指标与恶性心电生理事件（MAE）的相关性，探讨其预测价值。方法STEMI患者（溶栓组）57例，6h内成功溶栓且行药物保守治疗，分别测算溶栓前、溶栓后（7±1）d和（30±3）d梗死相关和非梗死相关导联QTc、TpIec、Tp—e／QT比值，随访1个月内MAE情况。采用t检验分析在溶栓前后不同时期上述心电学指标的变化，x^2检验分析其在不同节点对1个月MAE发生的差异。以60例正常人的心电图作为对照组。结果（1）溶栓组溶栓前的梗死相关和非梗死相关导联QTc、TO—eC和Yp—e／QT均大于正常对照组（P〈0．05），且在梗死和非梗死相关导联间差异均有统计学意义（P〈0．05）。溶栓后1周QTc在梗死和非梗死相关导联即回复至正常水平（P〉0．05）；而溶栓后1周、1个月时Tp—ec和Tp—e／QT较前一期相同导联显著减小（P〈0．05），且在梗死和非梗死相关导联间差异均有统计学意义（P〈0．05），仅Tp—ec溶栓后1个月时在非梗死相关导联回复正常（P〉0．05）。（2）溶栓组以溶栓前梗死相关导联QTc440ms作为节点分组，1个月内组间MAE发生差异无统计学意义（P〉0．05），分别以溶栓前梗死相关导联Tp—eC100InS和Tp—e／QT比值0．25作为节点分组，1个月组间MAE发生差异均有统计学意义[分别为28．1％（9／32）比4．0％（1／25），27．8％（10／36）比0，P均〈0．05]。结论STEMI患者溶栓前Tp．ec、Tp—e／QT比值的变化与1个月MAE的发生相关，可能成为新的预测指标。

Objective The prognostic value of corrected QT interval（ QTc）, corrected Tp-e interval （ Tp-ee ） and Tp-e/QT ratio on occurrence of malignant arrhythmia events （ MAE ） in acute ST-segment elevation myocardial infarction （STEMI） patients underwent successful thrombolysis was explored and the potential association of these indices with MAE was analyzed. Methods Fifty-seven STEMI patients underwent successful thrombolytie therapy within 6 hours after admission and conservative medical treatment were included. QTc, Tp-ec, Tp-e/QT ratio were obtained and calculated in infarct-related electrocardiograph leads and non-infarct-related leads before thrombolysis, （ 7± 1 ） days and （ 30 ± 3 ） days after thrombolysis respectively, and incidence of MAE up to 30 days after thrombolysis was analyzed. Sixty age and gender matched normal subjects served as control group. Results （ 1 ） QTc, Tp-ec, Tp-e/QT in infarct-related and non-infarct-related leads in STEMI group before thrombolysis were significantly higher than those in control group（ all P 〈 0. 05 ）, and values from the infarct-related leads were significantly higher than those from non-infarct-related leads in STEMI group （ all P 〈 0. 05 ）. QTc, Tp-ec and Tp-e/QT all significantly and continuously reduced from 7 days and at 30 days post thrombolysis compared the before thrombolysis（P 〈0. 05 vs. before thrombolysis）. （2） Tp-ec ≥ 100 ms and Tp-e/QT ratio 1〉0. 25 before thrombolysis in infarct-related leads were linked with higher incidence of MAE within 30 days post thrombolysis in this patient cohort [ 28.1% （9/32） vs. 40% （ 1/25）, 27.8% （10/36） vs. 0, respectively,all P 〈0.05 ]. Conclusion QTc, Tp-ec and Tp-e/QT values decreased post successful thrombolysis in STEMI patients and higher Tp-ec and Tp-e/QT values before thrombolysis in STEMI patients were related with higher MAE incidence up to 30 days post successful thrombolysis in this patient cohort.