不同NYHA分级慢性心力衰竭患者心肌纤维化指标水平与心电图变化的临床意义

Changes of myocardial fibrosis indexes and of ST-T and T peaks in patients with chronic heart failure with different NYHA classification and their clinical significance

目的探讨不同NYHA分级慢性心力衰竭患者心肌纤维化指标水平与心电图ST-T、T波峰末间期变化及临床意义。方法选取医院2014-10至2017-10收治的慢性心力衰竭(chronic heart failure,CHF)患者93例为治疗组,另选取同期健康体检者93例设为对照组。所有受检者均接受心电图检查,统计治疗组与对照组Tp-Te间期情况、治疗组不同NYHA分级患者间心电图ST-T变化及Tp-Te间期情况及血清心肌纤维化指标层粘连蛋白(LN)、前Ⅲ胶原(PCⅢ)、透明质酸(HA)水平,并统计分析心电图ST-T变化及Tp-Te间期与CHF患者心功能NYHA分级间相关性及血清LN、PCⅢ、HA水平与CHF患者心功能NYHA分级间相关性。结果治疗组Tp-Te(100. 23±19. 07) ms及Tp-Te/√RR(3. 71±0. 69) ms均大于对照组,RR(785. 67±123. 34) ms小于对照组(P <0. 05);不同NYHA分级患者间心电图ST-T改变程度、Tp-Te及RR、Tp-Te/√RR间存在统计学差异(P <0. 05),但Ⅱ级患者与Ⅲ级患者各指标间无统计学差异,Ⅳ级患者心电图ST-T改变程度高于Ⅱ级、Ⅲ级患者,Tp-Te及Tp-Te/√RR大于Ⅱ级、Ⅲ级患者,RR小于Ⅱ级、Ⅲ级患者(P <0. 05);单因素方差检验可知,不同NYHA分级患者血清LN、PCⅢ、HA水平间差异存在统计学意义(P <0. 05),多重比较,Ⅲ级患者血清LN、PCⅢ、HA水平高于Ⅱ级患者,Ⅳ级患者血清LN、PCⅢ、HA水平高于Ⅲ级患者(P <0. 05);心电图ST-T变化、Tp-Te及Tp-Te/√RR与NYHA分级间存在明显正相关关系(P <0. 05),RR与NYHA分级间存在明显负相关关系; LN、PCⅢ、HA水平与NYHA分级间存在明显正相关关系(P <0. 05)。结论 CHF患者心电图ST-T明显改变,T波峰末间期增大,心肌纤维化水平异常增高。

Objective To investigate the changes of myocardial fibrosis indexes and the end-stage changes of ST-T and T peaks in patients with chronic heart failure of different NYHA grades and their clinical significance. Methods Between October 2014 and October 2017,93 patients with CHF were enrolled in the study group,while another 93 healthy subjects were selected as the control group. All the subjects received an electrocardiogram examination. The Tp-Te intervals in both groups,ST-T changes and the Tp-Te intervals between the NYHA patients in the study group,and the serum myocardial fibrosis indexes [Laminin( LN),pre-Ⅲ collagen( PCⅢ),hyaluronic acid( HA) ]were calculated. The correlations of ECG ST-T changesand Tp-Te intervals with NYHA classification of CHF patients and between serum LN,PCⅢ,HA levels and NYHA classification of CHF patients were statistically analyzed.Results The Tp-Te( 100. 23 ± 19. 07) ms and Tp-Te/√RR( 3. 71 ± 0. 69) ms in the study group were larger than in the control group,and the RR( 785. 67 ± 123. 34) ms was smaller than in the control group( P < 0. 05). There was significant difference in ECG ST-T changes,Tp-Te and RR,Tp-Te/√RR between patients with different NYHA classification( P < 0. 05). However,there was no significant difference between the grade Ⅱ patients and grade Ⅲ patients. The level of ST-T changes in grade Ⅳ patients was higher than that in grade Ⅱ and Ⅲ patients,Tp-Te and Tp-Te/√RR were greater,but RR was lower than in grade Ⅱ and Ⅲ patients( P <0. 05). One-way ANOVA showed that there was significant difference in serum LN,PCⅢ,and HA levels between different NYHA patients( P < 0. 05). After multiple comparisons,serum LN,PCⅢ,and HA levels were higher in grade Ⅲ patients than those of gradeⅡ( P < 0. 05). Serum LN,PCⅢ,and HA levels were higher in grade IV patients than in grade Ⅲ patients( P < 0. 05). There was a significant positive correlation between ECG ST-T change,Tp-Te and Tp-Te/√RR and NYHA classification,but there was a significant negative correlation between RR and NYHA classification. There was a significant negative correlation between the grades( P < 0. 05),but there was a significant positive correlation between LN,PC Ⅲ,and HA levels and NYHA classification( P < 0. 05). Conclusions The ECG ST-T is significantly changed in patients with chronic heart failure,the end of T wave peak increases,and the level of myocardial fibrosis is abnormally increased.