心电图异常J波对急性ST段抬高型心肌梗死心律失常发生的预测价值

Predictive value of abnormal ECG J waves for arrhythmias in patients with acute ST elevation myocardial infarction

目的：探讨急性ST段抬高型心肌梗死（ASTEMI）患者心电图异常J波对短期内发生心律失常的预测价值。方法：回顾性分析2007年1月至2012年12月在我院行急诊冠脉介入治疗（PCI）的204例ASTEMI患者的心电图及心电监护记录资料。应用单因素、多因素Logistic回归分析心肌梗死1周内发生心律失常的影响因素。结果：204例患者中,心电图检获异常J波者82例（40.2%）,多数分布于心电图下壁导联。多因素Logistic回归分析显示,异常J波（OR=14.05,P=0.01,95%CI 1.70-116.40）、J波分布于≥2个部位（OR=13.38,P=0.01,95%CI 1.53-38.68）及J波振幅≥0.2mV（OR=4.28,P=0.02,95%CI 1.82-16.72）是持续性室速/室颤发生的独立预测因子,但不能作为包括非持续性室速、持续性室速、室颤在内的所有室性心律失常发生的预测因子（P均〉0.05）,亦不能预测房性心律失常的发生（P均〉0.05）。多因素Logistic回归分析显示,糖尿病是ASTEMI患者发生≥30s的房速及房颤的独立预测因子（OR=2.29,P=0.047,95%CI 1.01-5.18）。结论：心电图异常J波是ASTEMI后短期内发生持续性室速/室颤的独立预测因素。

Objective： To explore the predictive value of abnormal ECG J waves for arrhythmias occurred during short term in patients with acute ST elevation myocardial infarction （ASTEMI）. Methods： ECG and echocardio- graphic monitoring recordings of 204 ASTEMI patients who received emergency percutaneous coronary intervention （PCI） in our hospital from Jan 2007 to Dec 2012 were retrospectively analyzed. Univariate and multivariate Logistic regression analyses were performed to analyze the influencing factors of arrhythmias within one week after myocar- dial infarction. Results： Abnormal J waves detected by ECG were found in 82 cases （40.2%） among the 204 pa- tients, most of which were distributed on inferior leads of ECG. Multivariate Logistic regression analysis indicated that abnormal J waves （OR= 14.05, P = 0.01, 95%CI 1.70-116.40）, J waves distributed across ≥two locations （OR= 13.38, P = 0.01, 95%CI 1.53-38.68） and J wave amplitude≥0.2 mV （OR= 4.28, P ： 0.02, 95%CI 1.82-16.72） were independent predictors for sustained ventricular tachycardia/fibrillation （VT/VF）, but they cannot be used as predictors for occurrence of all ventricular arrhythmias, including non-sustained VT, sustained VT and VF （P〉0.05 all）, nor the occurrence of atrial arrhythmias, P〉0.05 all. Multivariate Logistic regression analysis indicated that diabetes mellitus was an independent predictor for occurrence of ≥30s atrial tachycardia/fibrillation in ASTEMI patients （OR = 2.29, P ： 0. 047, 95% CI 1.01-5.18）. Conclusion： Abnormal ECG J wave is an inde- pendent predictor for occurrence of sustained ventricular tachycardia/fibrillation during short term after ASTEMI.