心电图QRS波群终末部分改变在急性ST段抬高型心肌梗死患者危险分层中的价值

The value of terminal QRS distortion in risk stratification of acute ST-segment elevation myocardial infarction

目的探讨心电图QRS波群终末部分改变在急性ST段抬高型心肌梗死(STEMI)患者危险分层中的价值。方法2016年2月至2018年2月收治的STEMI患者165例,入院后按照心肌梗死溶栓治疗临床试验(TIMI)风险评分将患者分为低危、中危和高危者,比较QRS波群终末部分改变检出率。按照QRS波群终末部分改变情况分为QRS波群终末部分改变(观察组)和QRS波群终末部分未改变(对照组),比较两组一般临床资料、TIMI危险评分及心血管事件。结果QRS波群终末部分改变检出率高危者>中危者>低危者,组间比较差异具有统计学意义(P<0.05);观察组入院时心率、Killip分级≥2级、肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、B型脑钠肽(BNP)、随机血糖、C反应蛋白(CRP)水平高于对照组,左心室射血分数(LVEF)低于对照组,两组比较差异均有统计学意义(P<0.05或0.01);观察组TIMI风险评分[(5.84±1.62)分]显著高于对照组[(3.51±1.15)分],差异有统计学意义(t=10.349,P<0.01)。多元线性回归分析显示QRS波群终末部分改变与TIMI风险评分呈正相关(t=2.242,P<0.05);观察组心血管事件发生率(27.87%)高于对照组(12.50%),差异有统计学意义(χ2=5.959,P<0.05);多元logistic回归分析显示,QRS波群终末部分改变是STEMI患者发生心血管事件的独立危险因素(OR=2.219,95%CI:1.892-5.208,P<0.01)。结论心电图QRS波群终末部分改变可用于STEMI患者风险评估。

Objective To explore the value of terminal QRS distortion in risk stratification of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods 165 STEMI patients were enrolled from February 2016 to February 2018 and divided into low-risk,medium-risk and high-risk groups according to TIMI risk score. The incidence of the distortion of the terminal portion of QRS complex was compared among each group. The patients were divided into observation group(with terminal QRS distortion) and control group(without terminal QRS distortion). The clinical data,TIMI risk score and cardiovascular events were compared between the two groups.Results The incidence of terminal QRS distortion was high-risk group>middle-risk group>low-risk group,with significant difference between every two groups(P<0.05). Heart rate,Killip grade(>2),troponin I,creatine kinase isoenzyme,B-type brain natriuretic peptide,random blood sugar and C-reactive protein were significantly higher and left ventricular ejection fraction was significantly lower at admission in observation group than in control group(P<0.05 or 0.01). The TIMI risk score was significantly higher in observation group than control group[(5.84±1.62) vs.(3.51±1.15),t=10.349,P<0.01]. Multivariate linear regression analysis showed that terminal QRS distortion was positively correlated with TIMI risk score(t=2.242,P<0.05). Incidence of cardiovascular events was significantly higher in observation group than in control group[(27.87)% vs.(12.50)%,t= 5.959,P<0.05].Conclusion The distortion of the terminal portion of QRS complex may be used to risk evaluation of STEMI patients.