缺血性心肌病患者心源性猝死的预测因素分析

Predictors of sudden cardiac death occurrence in ischemic cardiomyopathy patients

目的 探讨缺血性心肌病（ICM）患者发生恶性心律失常及心源性猝死（SCD）的相关因素.方法 募集205例ICM住院患者作为病例组,回顾性调查患者心律失常发生情况.收集并检测患者心电图参数、左室射血分数（LVEF）和血浆尿钠肽（BNP）水平,出院后随访调查患者0.5 ～4年内心源性猝死（SCD）发生情况,分析病例组心电图QRS波群时限、LVEF值、BNP水平与恶性心律失常、SCD发生的关系.另选择年龄、性别匹配的40例健康人群作为对照组,比较病例组与对照组心电图QTc分布情况.结果 病例组心律失常发生率为60.9％（125例）,其中室性心动过速或心室颤动VT/VF 27例（13.2％）,与健康对照比较,病例组心电图QTc明显延长（P＜0.05）.随访结果标明,病例组心电图QRS波群时限延长患者（≥120 ms） SCD发生率明显高于QRS≤120 ms患者（35.1％和17.5％,P＜0.05）;血浆BNP水平明显升高组SCD发生率亦较BNP正常组高（24.8％和11.0％,P＜0.05）.随着LVEF值降低,SCD发生率有增高趋势,但差异无统计学意义.结论 ICM患者心电图QRS波群时限延长和血浆BNP明显升高与SCD发生相关,可作为预测SCD发生的高危因素,但与恶性心律失常（VT/VF）的关系尚需进一步研究.

Objective To investigate the related factors of malignant arrhythmia and sudden cardiac death （SCD） in ischemic cardiomyopathy （ICM） patients. Methods 205 ICM inpatients were recruited as case group. Tile occurrence of arrhythmia and electro- cardiogram （ECG） parameters, left ventricular ejection fraction （LVEF）, plasma brain natriuretic peptide （BNP） concentration were collected and detected as far as possible. And then, post - discharge follow - up was undertaken for 0.5 - 4 years to observe the relations of ECG QRS complex time, LVEF and BNP with occurrence of malignant arrhythmia and SCD. Additionally, 40 healthy and age, sex - matched subjects were selected as control group to compare the ECG QTc distribution with case group. Results The incidence of ar- rhythmia was 60.9% （n = 125 ）, with ventricular tachycardia or ventricular fibrillation （VT/VF） being 13.2% （ n = 27）. Compared with control group, the ECG QTc time was apparently longer （P 〈 0.05 ）. The follow - up results showed that incidence of SCD in pa- tients with ECG QRS≥ 120ms was significantly higher than those of QRS≤ 120 ms （23.0% versus 7.4%, P 〈 0. 01 ）. And the plasma BNP concentration was also related with SCD incidence positively （high level group 33.3% versus low level group 11.0%, P 〈 0.05）. The SCD occurrence was increased as LVEF decreased, but without statistical significance （P 〉 0.05）. Conclusion In ICM patients, the prolonged ECG QRS complex and high plasma BMP concentration is related with occurrence of SCD, which can be as predictors of SCD risk. But their relations with malignant arrhythmia remain unclear.