碎裂QRS波群对老年非ST段抬高性心肌梗死患者临床诊断及冠状动脉病变程度的预测价值

Predictive value of fragmented QRS wave group in the clinical diagnosis and the severity ofcoronary artery disease in elderly patients with NSTEMI

目的探究碎裂QRS（fQRS）波群对老年非sT段抬高性心肌梗死（NSTEMI）患者临床诊断及冠状动脉病变程度的预测价值。方法采用回顾性研究方式，选取2016—02—2017-02石河子大学医学院第-附属医院住院治疗的194例老年NSTEMI患者进行研究。根据标准12导联心电图（ECG）检查结果，分为fQRs波阳性组112例和fQRs波阴性组82例。计算fQRS波和病理性Q波发生率，以及敏感度和特异度，并分析两组患者冠脉病变数和冠脉狭窄程度。结果两组患者性别、吸烟史、高血压病、高脂血症、糖尿病、总胆固醇（TC）和低密度脂蛋白（LDL）水平比较差异无统计学意义（P〉0．05）。两组患者年龄差异有统计学意义（P〈0．05），fQRS波阳性组患者冠心病病史例数和Gensini评分明显高于fQRs波阴性组患者（P〈0．05）。fQRS波发生率明显高于病理性Q波发生率（P〈0．05），fQ·RS波诊断敏感度明显高于病理性Q波（P〈0．05），fQRS波与病理性Q波诊断特异度差异无统计学意义（P〉0．05）。fQRS波阳性组患者单支血管病变率明显低于fQRs波阴性组患者（P〈0．05），但双支及多支血管病变率fQRs波阳性组要明显高于fQRs波阴性组（P〈0．05），fQRs波阳性组患者冠状动脉狭窄程度明显高于fQRs波阴性组患者（P〈0．05）。对具有统计学意义单因素指标进行Logistic回归分析，老年NSTEMI患者年龄i〉70岁、既往冠心病史、冠脉病变支数≥2支、Gensini评分≥50分与心电图出现fQRS波具有相关性（P〈0．05）。结论fQRs波群对老年NSTEMI患者诊断敏感度较高，对预测患者冠脉病变支数和冠脉狭窄程度有-定价值，是诊断NSTEMI的-个非常重要指标，具有很大的临床应用价值。

Objective To explore the value of QRS wave group in the clinical diagnosis and the severity of coronary artery disease in elderly patients with non - ST - segment elevation myocardial infarction （NSTEM1）. Methods A retrospective study, from February 2016 to February 2017 in our hospital 194 cases of elderly patients with NSTEMI treatment were studied according to the results of standard 12 lead electrocardiogram （ECG） , the results were divided into fQRS positive group （n = 112） and fQRS wave positive （ n = 82）. To calculate the incidence and sensitivity and specificity of fQRS wave and pathological Q wave. The number of coronary lesions and the degree of coronary artery stenosis in two groups were analyzed. Results There was no significant difference in gender, smoking history,hypertension, hyperlipidemia, diabetes mellitus, TC and LDL between the two groups （P 〉 0.05）. The age difference between the two groups was significant （P 〈 0.05 ） , fQRS positive patients with coronary heart disease and Gensini score were significantly higher than those in the fQRS negative group （P 〈 0.05 ）. The broken QRS wave had a significantly higher incidence of pathologic Q wave incidence （ P 〈 0. 05 ）, the QRS wave breaking sensitivity was significantly higher than that of pathological Q wave （ P 〈 0.05）, QRS wave breaking and pathological Q wave diagnostic specificity had no significant difference （P 〉 0.05）. FQRS positive patients with single vessel disease was significantly lower than fQRS negative group （P 〈 0.05 ） , but double and multi vessel disease rate of fQRS positive group was significantly higher than that in fQRS negative group （ P 〈 0.05 ） degree of fQRS wave in patients with coronary artery stenosis positive group was significantly higher than that of fQRS negative patients （ P 〈 0.05 ）. The statistically significant univariate Logistic regression analysis showed that age, high Gensini score, coronary artery disease, coronary artery stenosis and coronary heart disease in elderly patients with NSTEMI ECG fQRS wave has positive correlation （ P 〈 0.05 ）. Conclusion fQRS wave is sensitive to the diagnosis of elderly patients with NSTEMI, has a certain value in predicting the number and degree of coronary artery stenosis in patients with coronary artery disease, is a very effective index for the diagnosis of NSTEMI, has great value in clinical application.