高龄和日间舒张压高及反杓型是高血压患者心电图碎裂QRS波的独立影响因素

Advanced age,high daytime diastolic blood pressure and reversedipper type are independent influencing factors of electrocardiogram fragmented QRS complex in hypertensive patients

目的:分析高血压患者碎裂QRS波(fQRS)产生的危险因素及其与非杓型和反杓型血压模式的关系。方法:选择2019年3月至2019年12月海口市人民医院全科医学科338例连续新诊断尚未治疗的高血压患者,且无左心室肥厚并接受24 h动态血压监测。根据动态血压监测结果,患者被分为杓型、非杓型和反杓型。比较各组心电图fQRS发生率。结果:90例(26.6%)患者在心电图上有fQRS。与无fQRS患者相比,fQRS患者年龄较大(P=0.005),日间、夜间、24 h平均收缩压(SBP)和舒张压(DBP)显著升高(P均<0.05)。单因素Logistic回归分析结果发现:日间DBP、夜间SBP、年龄、非杓型、反杓型是高血压患者fQRS波的影响因素。多因素Logistic回归分析显示,日间DBP(P<0.001,95%CI:0.901~0.955);年龄(P<0.001,95%CI:0.814~0.941);、反杓型(P=0.018,95%CI:1.132~3.684)是高血压患者fQRS波的独立影响因素。结论:高龄、日间舒张压高及反杓型高血压患者心电图可能较易出现fQRS波,虽然此类患者无明显左心室肥大,但可提示心肌纤维负荷增加。

Objective:To analyze the risk factors of fragmented QRS complex(fQRS)and its relationship with non-dipper and reverse-dipper blood pressure patterns in hypertensive patients.Methods:A total of 338 consecutive patients with newly diagnosed and untreated hypertension in General Practice Department of Haikou People's Hospital from March 2019 to December 2019 were enrolled in this study.These patients had no left ventricular hypertrophy and received 24 h ambulatory blood pressure monitoring.According to the results of ambulatory blood pressure monitoring,patients were classified as dipper,non-dipper and reverse-dipper.The incidence of fQRS was compared among the groups.Results:Totally,90 patients(26.6%)had fQRS on ECG.The patients with fQRS were older(P=0.005).As compared with the patients without fQRS,the mean systolic blood pressure(SBP)and diastolic blood pressure(DBP)in daytime,night and 24 h in the patients with fQRS were significantly increased(all P<0.05).Univariate logistic regression analysis showed that daytime DBP,nighttime SBP,age,non-dipper type and reverse-dipper were the influencing factors of fQRS in patients with hypertension.The multivariate logistic regression analysis revealed that daytime DBP(P<0.001,95%CI:0.901-0.955),age(P<0.001,95%CI:0.814-0.941)and reverse-dipper type(P=0.018,95%CI:1.132-3.684)were independent influencing factors of fQRS in patients with hypertension.Conclusion:The fQRS may be more likely to appear in elderly patients,with high daytime DBP and reverse-dipper hypertension.Although there is no significant left ventricular hypertrophy in these patients,fQRS may indicate increased myocardial fiber load.