老年慢性心力衰竭患者血清D-二聚体水平对心电图QRS波时限的影响

目的探讨老年慢性心力衰竭（CHF）患者血清D-二聚体（D-D）水平对心电图QRS波时限的影响。方法老年CHF患者212例，按照入院时血清D-D水平分为D-D升高组（〉400μg／L，72例）及D-D正常组（≤400μg／L，140例），收集两组一般临床资料及心电图QRS波时限指标，比较两组差异；应用多元回归方程分析血清D-D水平与心电图QRS波时限的关系。结果D-D升高组与D—D正常组在ACEI／ARB类药物、左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、N末端B型脑钠肽前体（NT-proBNP）、QRS波时限分布情况及平均时限方面差异有统计学意义（P〈0．05）；Pearson相关分析显示D-D水平与QRS波时限成正相关（r=0．266，P〈0．05），亦与NT-proBNP、LVEDD成正相关。而与LVEF成负相关（P〈0．05）；多元线性回归方程显示D-D水平是影响QRS波时限的独立危险因素（B=0．540，t=3．652，P〈0．05）。结论血清D—D水平增高能够在一定程度上影响CHF患者QRS波时限，可能是QRS波时限延长的独立危险因素，临床中应加强对患者高凝状态的干预，以促进QRS波时限恢复，改善患者预后。

Objective To investigate the effect of the serum D-dimer （ D-D ） level on QRS duration in chronic heart failure （ CHF ） . Methods 212 cases in elderly patients with CHF were divided into increased D-D group （〉400μg/L, 72cases） and normal D-D group （ ≤400μg/ L, 72 cases ） according to the level of serum D-D on admission, two groups of general clinical information and electrocardiogram QRS duration were collected and compared. Relationship between the serum D-D level and QRS duration was analyzed using the multivariate regression equation. Results There were statistically significant different in ACEI/ARB drugs, left ventricular ejection fraction （ LVEF ） , left ventricular end-diastolic diameter （ LVEDD ） , N terminal B-type brain natriuretic peptide precursor （ NT-proBNP ） , QRS distribution and average duration between increased D-D group and normal D-D group （ P〈0.05 ） . Pearson correlation analysis showed that the D-D level was positively correlated with the QRS duration （ r=0.266, P〈0.05 ） , was positively associated with NT-proBNP, LVEDD respectively, and negative correlation with LVEF （ P〈0.05 ） . The multivariate linear regression equation showed that the D-D level was an independent risk factor affecting the QRS duration （ β =0.5401 t=-3.652, P〈0.05 ） . Conclusion Increased serum D-D level has a certain extent affect on the QRS duration in CHF patients, and may be an independent risk factors for QRS duration, clinical intervention should be strengthen to deal with high coagulation state, to promote the QRS duration so as to improving the prognosis of patients.