窦性心率震荡对急性心肌梗死患者预后的预测价值

The predictive value of sinus heart rate turbulence in the prognosis of patients with acute myocardial infarction

目的探讨窦性心率震荡（HRT）对急性心肌梗死（AMI）患者预后的预测价值。方法选取90例AMI患者为观察组，另随机选取90例健康志愿者作为对照组，对两组患者进行24h动态心电图（Holter）监测，定量测量HRT的两个参数震荡初始（TO）和震荡斜率（TS），并获取心率变异（HRV）参数、24h内R-R期间的标准差（SDNN）、QT间期变异度（QTV）、QT问期变异系数（QTCV）及左室射血分数（LVEF）等传统指标。结果观察组TS、SDNN值分别为（12．54±8．61）ms／RR间期、（93．24±23．02）ms，均较对照组明显降低（t=2．193、4．130，均P〈0．05）。对观察组90例AMI患者作12～24个月随访，期间死亡14例，存活76例。存活组TS、LVEF值分别为（6．73±5．12）ms／RR间期、（0．574-0．15）cm，较死亡组显著性升高（t=7．956、4．590，均P〈0．05）。通过单变量COX回归分析结果显示TS（RR=0．624，P=0．013）、LVEF（RR=0．825，P=0．011）、QTV（RR=0．754，P=0．030）三个指标均对高危AMI患者的预测具有统计学意义；将TO与TS相结合作为单一变量进行多变量COX回归分析，结果显示TO与Ts相结合对AMI有着更佳的预测价值（RR=2．984，P=0．029），优于LVEF（RR=0．208，P=0．052）、QTV（RR=0．158，P=0．074）等指标。结论HRT作为新的心电学指标，对AMI患者预后的预测价值明显优于传统指标。

Objective To explore the clinical value of sinus heart rate turbulence（HRT） in predicting the prognosis of patients with acute myocardial infarction （AMI）. Methods 90 AM1 patients were selected as the obser- vation group. 90 healthy volunteers were randomly selected as the control group. 24 h ambulatory electrocardiogram was monitored in two groups of patients. The two parameters of HRT turbulence onset（TO） and turbulence slope（TS） were quantitatively measured. The heart rate variability（HRV） parameters and the traditional indicators of SDNN,QT interval variability（ QTV）, QT interval coefficient of variation （QTCV） and left ventricular ejection fraction （LVEF） were measured. Results The TS, SDNN of the observation group were （ 12. 54 ± 8. 61 ） ms/RR interval and （93.24 ±23.02）ms, which were significantly lower than those of the control group （t = 2. 193,4. 130, all P 〈 0.05 ）. 90 AblI patients in the observation group were followed up for 12 to 24 months, 14 patients died ,76 cases survived. TS and LVEF of the survival group were （6.73 ±5.12）ms/RR interval and （0.57 ±0. 15 ）cm, which were significantly higher than those of the death group（ t = 7. 956,4.590, all P 〈 0.05 ）. Univariate COX regression analysis showed thatTS （ RR = 0.624, P = 0.013 ）, LVEF （ RR = 0.825, P = 0.011 ）, QTV （ RR = 0.754, P = 0.030 ） had statistical signifi- cance in the prediction of high-risk AMI patients. TO and TS combined as a single variable to conduct multivariate COX regression analysis, the results showed that the combination of TO and TS had better predictive value in AMI （ RR =2. 984 ,P =0. 029） than LVEF（ RR =0. 208 ,P =0. 052） ,QTV（ RR =0. 158 ,P =0. 074）. Conclusion HRT as a new heart electrical indicators has better prognostic value in patients with AMI than traditional indicators.