血清25-羟维生素-D3 超敏C反应蛋白及心电图参数与ST段抬高型心肌梗死患者介入治疗后发生恶性心律失常的关系

Relationship between Serum 25-(OH)-D3, hs-CRP and ECG Parameters andMalignant Arrhythmia in Patients with STEMI after Interventional Therapy

目的:探讨血清25-羟维生素-D3(25-hydroxyvitamin D3,25-(OH)-D3)、超敏C反应蛋白(High sensitivity C-reactive protein,hs-CRP)、心电图参数变化与ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者经皮冠脉介入术(Percutaneous coronary intervention,PCI)后发生恶性心律失常的关系。方法:选取我院2020年1月至2022年6月实施PCI治疗的193例STEMI患者作为研究对象,根据患者术后72h内是否发生恶性心律失常分为心律失常组38例、对照组155例,对比两组患者入院12h内的25-(OH)-D3、hs-CRP、血清电解质、血常规指标、血脂指标、心肌酶学指标,并对患者PCI术后实施连续动态心电图监测,对比两组患者心电图碎裂QRS波、校正Tp-e间期(Corrected Tp-e interval,Tp-ec)、QT离散度(QT dispersion,Qtd),并采用Logistic回归模型分析上述指标与STEMI患者PCI术后发生恶性心律失常的关系。结果:心律失常组患者的血清25-(OH)-D3水平低于对照组,心律失常组患者的血清hs-CRP、Tp-ec测定值、Qtd测定值、碎裂QRS波检出率均高于对照组,上述指标组间差异均具有统计学意义(P<0.05);心律失常组患者的白细胞(White blood cell,WBC)、肌钙蛋白I(Troponin I,cTnI)、肌酸激酶同工酶(Creatine kinase isoenzyme,CK-MB)、肌红蛋白(Myoglobin,MYO)、K+、Mg 2+水平均高于对照组患者,差异具有统计学意义(P<0.05);Logistic回归模型结果显示:cTnI、CK-MB、K+、hs-CRP、Tp-ec、Qtd增高,碎裂QRS波阳性会显著增大STEMI患者PCI后发生恶性心律失常的风险(P<0.05);血清25-(OH)-D3水平增高会降低STEMI患者PCI后发生恶性心律失常的风险(P<0.05)。结论:STEMI患者血清25-(OH)-D3水平降低、hs-CRP增高、PCI术后Tp-ec、Qtd增高、出现碎裂QRS波会增大患者出现恶性心律失常的风险。

Objective:To investigate the relationship between the changes of serum 25 hydroxyvitamin D3(25-(OH)-D3),high sensitivity C-reactive protein(hs CRP),ECG parameters,and malignant arrhythmia after percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STEMI).Methods:A total of 193 STEMI patients who underwent PCI in our hospital from January 2020 to June 2022 were selected as the research subjects.According to whether the patients had malignant arrhythmias within 72 hours after surgery,they were divided into the arrhythmia group of 38 cases and the control group of 155 cases.The 25-(OH)-D3,hs-CRP,serum electrolytes,blood routine indexes,blood lipid indexes,and myocardial enzyme indexes of the patients in the groups were compared within 12 hours of admission,and the patients were monitored by continuous dynamic electrocardiogram after PCI.The fragmented QRS complex,corrected Tp-e interval(Tp-ec),QT dispersion(Qtd),and logistic regression model were used to analyze the relationship between the above indicators and the occurrence of malignant arrhythmia in STEMI patients after PCI.Results:The level of serum 25-(OH)-D3 in patients with arrhythmia was lower than that in the control group.The detection rates of hs CRP,Tp-ec,Qtd,and fragmented QRS waves in patients with arrhythmia were higher than those in the control group.The differences between the above indicators were statistically significant(P<0.05);the levels of white blood cell(WBC),troponin I(cTnI),creatine kinase isoenzyme(CK-MB),myoglobin(MYO),K+,Mg 2+;logistic regression model showed that cTnI,CK-MB,potassium ion,hs CRP,Tp-ec,and Qtd increased,and positive fragmented QRS wave significantly increased the risk of malignant arrhythmia in STEMI patients after PCI(P<0.05);the increase of serum 25-(OH)-D3 level will reduce the risk of malignant arrhythmia in STEMI patients after PCI(P<0.05).Conclusion:The decrease of serum 25-(OH)-D3 level,the increase of hs-CRP,the increase of Tp-ec and Qtd after PCI,and the occurrence of the fragmented QRS complex in STEMI patients will increase the risk of malignant arrhythmia in patients.