心电学指标Tp-e/QT对急性缺血性脑卒中患者临床转归的预测价值

PREDICTIVE VALUE OF TP-E/QT FOR CLINICAL OUTCOME OF ACUTE ISCHEMIC STROKE PATIENTS

目的 分析心电学指标Tp-e/QT对急性缺血性脑卒中(AIS)患者短期临床转归的预测价值。方法 采用前瞻性临床观察的方法,选择2019年08月—2021年08月入该院初次确诊AIS患者共188例,根据出院改良Rankin量表评分分为转归良好组113例(0~2分)和不良组75例(>2分)。比较两组患者的一般临床资料和心电学指标,包括校正后QT间期离散度(QTcd)、校正后Tp-e间期(Tp-ec)、Tp-e/QT比值和Tpec离散度(Tp-ecd)。结果 不良组患者比良好组年龄增大、基线美国国立卫生研究院卒中量表(NIHSS)评分升高,入院QTcd、Tp-ec、Tp-e/QT和Tp-ecd值均明显升高,差异有统计学意义(P<0.05)。单因素或者多因素Logistic回归分析显示,高龄、NIHSS评分、QTcd、Tp-ec、Tp-e/QT和Tp-ecd值升高是转归不良的独立危险因素(P<0.05)。受试者工作曲线(ROC)显示,Tp-e/QT预测转归不良的曲线下面积(AUC)值高于其他三个心电学指标(P<0.05)。结论 心电学指标Tp-e/QT升高与AIS患者短期临床转归不良密切相关,有较好的预测效能,可作为早期临床识别预后不良高危患者的重要无创指标。

Objective To analyze the predictive value of Tp-e/QT for short-term clinical outcome in patients with acute ischemic stroke(AIS).Methods A total of one hundred and eighty-eight patients with AIS diagnosis for the first time into our hospital from August 2019 to August 2021 were chosed in the prospective clinical observation.According to the modified Rankin Scale score when discharge from hospital,they were divided into better outcome group(n=113,0~2 points) and worse outcome group(n=75,more than 2 points).The general clinical datas and cardiac electrical parameters,including corrected QT interval dispersion(QTcd),corrected Tp-e interval(Tp-ec),Tp-e/QT and Tp-ec dispersion(Tp-ecd) were compared between the two groups.Results The patients in worse group were elderly than better group,the baseline NIHSS score was higher,the QTcd,Tp-ec,Tp-e/QT and Tp-ecd values were higher,too(P<0.05).Univariate or multivariate logistic regression analysis showed that elderly age,higher NIHSS score,QTcd,Tp-ec,Tp-e/QT and Tp-ecd values were the independent risk factors to worse prognosis(P<0.05).The receiver operating curve(ROC) showed that the area under the curve(AUC) value of Tp-e/QT was higher than the other three cardiac electrical parameters for worse prognosis(P<0.05).Conclusion The increasement of Tp-e/QT is closely related to the worse short-term clinical outcome of AIS patients,which can be used as an important noninvasive index for early clinical identification of high-risk patients with worse prognosis.