R波峰值时间与ACS患者冠状动脉病变严重程度的关系

Relationship between RWPT and severity of coronary artery disease in ACS patients

目的:探讨急性冠脉综合征(ACS)患者的R波峰值时间(RWPT)与冠脉病变严重程度之间的关系。方法:回顾性分析我院139例ACS患者的临床资料,根据Gensini评分,被分为Gensini评分≥25分(中重度冠脉病变)组(78例)和Gensini评分<25分(轻度冠脉病变)组(61例),比较两组一般临床资料、RWPT、QRS时限、PR段等,分析ACS患者冠脉病变严重程度的独立预测因子及其预测价值。结果:与Gensini评分<25分组比较,Gensini评分≥25分组吸烟史比例(13.8%比27.3%)、白细胞计数[5.86(3.49,8.23)×10^(9)/L比7.13(3.26,11)×10^(9)/L]、空腹血糖[5.41(4.27,6.55)mmol/L比6.07(3.33,8.81)mmol/L]、肌酸激酶同工酶(CK-MB)[11.2(7,11.25)U/L比12.5(7,28)U/L]、D二聚体[0.21(0.13,0.37)mg/L比0.31(0.16,0.66)mg/L]水平和RWPT[30(25.75,32)ms比30(27.25,35)ms]、QRS时限[80(75,82)ms比85(75,90)ms]显著增加,血钠[141.3(138.1,144.5)mmol/L比140.55(137.35,143.75)mmol/L]水平显著降低,P<0.05或<0.01。多因素Logistic回归分析显示,RWPT是Gensini评分≥25分的独立危险因子(OR=1.087,P=0.024);ROC曲线显示,RWPT的截断值为34.5ms,其诊断Gensini评分≥25分的敏感性为47.4%,特异性为91.8%[曲线下面积(AUC):0.650,95%CI:0.559~0.741,P=0.002]。结论:RWPT是Gensini评分≥25分的独立危险因子,其预测冠脉病变的特异性高,敏感性较低。

Objective:To investigate the relationship between R wave peak time(RWPT)and severity of coronary artery disease(CAD)in patients with acute coronary syndrome(ACS).Methods:Clinical data of 139 ACS patients were retrospectively analyzed.According to Gensini score,patients were divided into Gensini score≥25 scores(medium-severe CAD)group(n=78)and Gensini score<25 scores(mild CAD)group(n=61).General clinical data,RWPT,QRS duration and PR segment etc.were compared between two groups.Independent predictors of CAD severity and their predictive value were analyzed in ACS patients.Results:Compared with Gensini scores<25 scores group,there were significant rise in percentage of smoking(13.8%vs.27.3%),white blood cell count[5.86(3.49,8.23)×10^(9)/L vs.7.13(3.26,11)×10^(9)/L],levels of fasting blood glucose[5.41(4.27,6.55)mmol/L vs.6.07(3.33,8.81)mmol/L],creatine kinase isoenzyme MB(CK-MB)[11.2(7,11.25)U/L vs.12.5(7,28)U/L],D-D[0.21(0.13,0.37)mg/L vs.0.31(0.16,0.66)mg/L],RWPT[30(25.75,32)ms vs.30(27.25,35)ms]and QRS duration[80(75,82)ms vs.85(75,90)ms],and significant reduction in blood sodium level[141.3(138.1,144.5)mmol/L vs.140.55(137.35,143.75)mmol/L]in Gensini score≥25 scores group,P<0.05 or<0.01.Multivariate Logistic regression analysis indicated that RWPT was independent risk factor for Gensini score≥25 scores(OR=1.087,P=0.024);ROC curve indicated that cutoff point of RWPT was 34.5ms,its sensitivity and specificity of diagnosing Gensini score≥25 scores was 47.4%and 91.8%respectively,area under curve(AUC)was 0.650,95%CI:0.559~0.741,P=0.002.Conclusion:RWPT is an independent risk factor for Gensini score≥25 scores,the specificity is high and sensitivity is low in predicting coronary disease.