老年de Winter综合征患者临床特点与心电图特征分析

Clinical characteristics and electrocardiographic features analysis of elderly de Winter syndrome patients

目的探讨老年de Winter综合征患者的临床特点及心电图特征。方法回顾性纳入2018年1月至2022年1月就诊于沧州市人民医院的符合de Winter综合征样心电图改变的急性心肌梗死患者,按照年龄分为老年de Winter组(36例)和非老年de Winter组(37例),另选择同期诊治老年急性前壁ST段抬高型心肌梗死患者461例为对照组。记录各组患者的临床资料、实验室检查指标和心电图特征。结果与非老年de Winter组比较,老年de Winter组的男性比例、年龄、高血压、脑梗死、左前降支单支病变比例、低密度脂蛋白胆固醇及空腹血糖等差异均有统计学意义(均为P<0.05);与对照组比较,老年de Winter组的男性、高血压、吸烟史等比例和空腹血糖水平等的差异均有统计学意义(均为P<0.05)。73例de Winter患者中,心电图动态演变者共有49例(67.1%)。老年de Winter组和非老年de Winter组的心电图动态演变者的比例相似(22例比27例,61.1%比73.0%),差异无统计学意义(χ^(2)=1.163,P=0.281)。老年de Winter组和非老年de Winter组的发病后de Winter图形出现的时间差异无统计学意义(t=0.633,P=0.529)。在49例心电图动态演变者中,两组心电图出现de Winter图形后出现ST段抬高的时间差异也无统计学意义(t=1.188,P=0.241)。此外,两组胸导J点压低最深值[(2.35±1.32)mm比(2.58±1.34)mm]及T波振幅最高值[(11.28±3.12)mm比(11.46±3.95)mm]比较均无统计学差异(均为P>0.05)。结论老年患者在de Winter综合征中占比不低于中青年,但心电图特征无特异性。

Objective To explore the clinical characteristics and electrocardiographic features of elderly de Winter syndrome patients.Methods A retrospective study was conducted on acute myocardial infarction patients with de Winter syndrome-like electrocardiographic changes who were treated at Cangzhou People’s Hospital from January 2018 to January 2022.The patients were divided into an elderly de Winter syndrome group(36 cases)and a non-elderly de Winter syndrome group(37 cases)based on age.A control group of 461 elderly patients with acute anterior wall ST segment elevated myocardial infarction treated during the same period was also selected.Clinical data,laboratory examination results,and electrocardiographic features were recorded for all groups.Results Compared with the non-elderly de Winter syndrome group,the elderly de Winter syndrome group showed significant differences in terms of male proportion,age,rates of hypertension,stroke,left anterior descending branch involvement,levels of low-density lipoprotein cholesterol and fasting blood glucose(all P<0.05).Compared with the control group,the elderly de Winter syndrome group showed significant differences in terms of male proportion,rates of hypertension,smoking history,and fasting blood glucose level(all P<0.05).Among the 73 de Winter syndrome patients,49(67.1%)showed dynamic electrocardiographic changes.The proportion of patients with dynamic electrocardiographic changes was similar between the elderly and non-elderly de Winter syndrome groups(22 cases vs.27 cases,61.1%vs.73.0%),with no significant difference(χ^(2)=1.163,P=0.281).The time of appearance of the de Winter pattern after onset of symptoms was similar between the elderly and non-elderly de Winter syndrome groups,with no significant difference(t=0.633,P=0.529).Among the 49 patients with dynamic electrocardiographic changes,the time of ST segment elevation after the appearance of the de Winter pattern was similar between the two groups,without significant difference(t=1.188,P=0.241).Additionally,there were no significant differences in the deepest J-point depression[(2.35±1.32)mm vs.(2.58±1.34)mm]and the highest T-wave amplitude[(11.28±3.12)mm vs.(11.46±3.95)mm]between the two groups(both P>0.05).Conclusions Elderly patients account for a considerable proportion of de Winter syndrome cases,but the electrocardiographic features are not specific.