碎裂QRS波及BNP预测急性心肌梗死范围与心脏事件的研究

Fragmented QRS scale and brain natriuretic peptide predict infarction in patients with acute myocardial infarction and heart attacks

目的 研究急性心肌梗死（AMI）患者心电图出现碎裂QRS波（fQRS）及脑钠肽（BNP）水平与冠脉病变范围、严重心脏并发症及心源性死亡的相关性.方法 连续入选AMI患者,依据心电图是否出现fQRS分成fQRS组和无fQRS组;应用免疫荧光法对AMI患者进行血浆BNP水平检测.观察两组患者严重心脏事件发生情况及冠脉病变范围;冠脉病变支数与BNP水平的关系.结果 急性心肌梗死患者碎裂QRS波的发生率为34.0％,fQRS波组高度/三度房室阻滞、室速/室颤、心源性休克、心源性死亡发生率高于无fQRS波组（P＜0.05）.fQRS波组血浆BNP、左室舒张末内径、多支病变均显著高于无fQRS组（P＜0.01）,左室射血分数、单支病变显著低于无fQRS波组（P＜0.01）.BNP水平在单支、双支、多支病变组中随着病变支数的增加而逐渐升高.结论 急性心肌梗死患者出现fQRS波易并发严重心律失常,且病死率高,预后差.心电图上fQRS的出现及BNP水平与冠脉病变范围及程度有一定的关系,可作为预测冠脉病变程度的指标,对于多支病变有一定的预测价值.

Objective To investigate the acute myocardial infarction （AMI） patient＆#39;s electrocardiogram appearing fragment QRS wave （fQRS） and brain natriuretic peptide （BNP） level and scope of coronary lesions,severe cardiac complications,and the cor relation of cardiac death.Methods For selected patients with AMI,whether based on electrocardiogram （ECG） appeared in fQRS group and non fQRS groups; immunofluorescence technique was used to detect the plasma BNP level in patients with AMI.Two groups of patients with serious cardiac events and coronary artery lesions scope were observed; Coronary artery lesion count and BNP level were recorded.Results The incidence of fragment QRS wave in patients with AMI was 34.0%,fQRS wave group height/three degree atri oventricular block,ventricular tachycardia/ventricular fibrillation,cardiac shock,cardiac death rate was higher than non fQRS wave group （P 〈0.05）.fQRS wave group of plasma BNP and left ventricular end-diastolic diameter,the double branch lesion,multivessel lesions were significantly higher than that of non fQRS group （P 〈 0.01） ; left ventricular ejection fraction,the single lesion was sig nificantly lower than non fQRS wave group （P 〈0.01）.The BNP levels in single,double,and multivessel lesions in the group with the increase of the lesion count were increased.Conclusions The AMI patients with fQRS easily complicated with severe arrhythmia,and case fatality rate was high,the prognosis was poor.fQRS on electrocardiogram （ECG） and BNP level had a certain relationship with range and degree of coronary artery lesions,degree of indexes might be used as a prediction of coronary lesions,and multivessel lesions had certain prediction value.