急性ST段抬高型心肌梗死患者碎裂QRS波形成的危险因素

Risk Factors of Fragmented QRS Complex in Patients with Acute ST-segment Elevation Myocardial Infarction

目的分析急性ST段抬高型心肌梗死(STEMI)患者碎裂QRS波(fQRS)形成的相关危险因素。方法选择2020年1月至2022年1月在亳州市人民医院就诊的144例临床诊断为STEMI的患者。根据心电图是否出现fQRS分为fQRS组(47例)和非fQRS组(97例),对可能影响fQRS形成的因素(性别、年龄、既往病史、入院时生理指标和实验室指标)进行单因素分析,采用多因素Logistic回归分析fQRS形成的危险因素。结果fQRS组冠状动脉Gensini评分、白细胞计数、血清胱抑素C(CysC)水平高于非fQRS组[(52.36±20.61)分比(40.15±11.27)分、(12.31±2.92)×10^(9)/L比(10.02±1.06)×10^(9)/L、(1.39±0.41)mg/L vs(1.12±0.34)mg/L](P<0.01),左心室射血分数低于非fQRS组[(40.27±5.18)%比(44.27±6.21)%](P<0.01),且两组不同冠状动脉病变范围分布差异有统计学意义(P<0.01)。Logistic回归分析结果显示,冠状动脉Gensini评分、冠状动脉双支及以上病变、白细胞计数、血清CysC是影响STEMI患者fQRS形成的独立危险因素(OR=2.337,95%CI 1.659~2.706;OR=2.251,95%CI 2.065~3.137;OR=2.154,95%CI 1.982~2.538;OR=2.266,95%CI 1.923~2.629,P<0.05或P<0.01)。结论STEMI患者fQRS的形成与冠状动脉Gensini评分、冠状动脉病变范围、白细胞计数、血清CysC水平有关,fQRS可在一定程度上反映冠状动脉的病变程度。

Objective To analyze the risk factors affecting the formation of fragmented QRS complex(fQRS)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 144 patients with STEMI treated in Bozhou People′s Hospital from Jan.2020 to Jan.2022 were collected.According to whether there was fQRS on the electrocardiogram,they were divided into a fQRS group(47 cases)and a non-fQRS group(97 cases).The factors that might affect the formation of fQRS(gender,age,previous medical history,physiological indicators and laboratory indicators at admission)were analyzed by single factor analysis,and the risk factors affecting the formation of fQRS were analyzed by multiple factor Logistic regression.Results The coronary artery Gensini score,white blood cell count and serum cystatin C(CysC)level in the fQRS group were higher than those in the non-fQRS group[(52.36±20.61)vs(40.15±11.27),(12.31±2.92)×10^(9)/L vs(10.02±1.06)×10^(9)/L,(1.39±0.41)mg/L vs(1.12±0.34)mg/L](P<0.01),the left ventricular ejection fraction was lower in the non-fQRS group[(40.27±5.18)%vs(44.27±6.21)%](P<0.01),and there was a statistically significant difference in the distribution of different coronary artery lesions between the two groups(P<0.01).The results of Logistic regression analysis showed that the Gensini score of coronary artery,lesions of two or more branches of coronary artery,white blood cell count and serum CysC level were independent risk factors affecting the formation of fQRS in STEMI patients(OR=2.337,95%CI 1.659-2.706;OR=2.251,95%CI 2.065-3.137;OR=2.154,95%CI 1.982-2.538;OR=2.266,95%CI 1.923-2.629,P<0.05 or P<0.01).Conclusion The formation of fQRS in patients with STEMI is related to coronary artery Gensini score,coronary artery lesion range,white blood cell count,and serum CysC level,so fQRS can reflect the degree of coronary artery lesion to a certain extent.