摘要
目的:分析心电图复极相关参数对急性心肌梗死(Acute myocardial infarction,AMI)患者恶性心律失常的预测价值。方法:选取2020年1月至2023年12月期间本院收治的65例AMI患者作为研究对象。全部患者入院时接受心电图检查,得到心电图复极相关参数(胸导QT均值、胸导QTc均值)。检测心肌损伤标志物[肌钙蛋白(Cardiac troponin I,cTnI)、肌酸激酶同工酶(Creatine kinase isonenzymes,CKMB)以及N端脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)]水平。根据住院期间是否发生恶性心律失常,将患者分为发生组与未发生组。分析心电图复极参数对AMI患者恶性心律失常的预测价值。结果:65例AMI患者中50例发生恶性心律失常,发生率为76.92%。发生组的cTnI、CKMB、NT-proBNP水平均明显高于未发生组,胸导QT间期均值、胸导QTc间期均值均明显低于未发生组(P<0.05)。受试者工作特征曲线(Receiver Operating Characteristic,ROC)结果显示,AMI患者入院时心电图复极参数胸导QT均值、胸导QTc均值预测恶性心律失常的曲线下面积(Area Under Curve,AUC)分别为0.780、0.837,有中等预测价值,联合预测AUC为0.882,联合预测价值更高。结论:AMI患者心电图复极参数存在异常表现,主要表现为胸导QT间期均值与胸导QTc间期均值减小,二者可用于预测AMI患者恶性心律失常风险,且联合预测价值理想。
Objective:To analyze the value of ECG repolarization parameters in predicting malignant arrhythmia in patients with acute myocardial infarction(AMI).Methods:65 patients with AMI admitted to our hospital from January 2020 to December 2023 were selected as the study objects.All patients were received electrocardiogram(ECG)examination upon admission,and the relevant parameters of ECG repolarization(mean value of thoracic conduction QT and mean value of thoracic conduction QTc)were obtained.Myocardial injury markers[cardiac troponin I(cTnI),creatine kinase isonenzymes,CKMB and N-terminal pro-brain natriuretic peptide(NT-proBNP)]were tested.According to whether malignant arrhythmias occurred during hospitalization,the patients were divided into the occurrence group and the non-occurrence group.The predictive value of ECG repolarization parameters for malignant arrhythmia in patients with AMI was analyzed.Results:Malignant arrhythmia occurred in 50 of 65 patients with AMI(76.92%).The levels of cTnI,CKMB and NT-proBNP in the occurrence group were significantly higher than those in the non-occurrence group,and the mean of thoracic conduction QT interval and thoracic conduction QTc interval were significantly lower than those in the non-occurrence group(P<0.05).Receiver operating characteristic(ROC)curve results showed that the AUC predicted by ECG repolar parameters of thoracic conduction QT mean and thoracic conduction QTc mean on admission of AMI patients was 0.780 and 0.837,respectively,with moderate predictive value.Combined predictive area under curve(AUC)was 0.882,with higher predictive value.Conclusion:There are abnormal ECG repolarization parameters in patients with AMI,mainly manifested as decreased mean of thoracic conduction QT interval and mean of thoracic conduction QTc interval.The two can be used to predict the risk of malignant arrhythmia in patients with AMI,and the combined prediction value is ideal.
作者
黄晓静
Huang Xiao-jing(Department of Electrocardiography,The Sixth People's Hospital of Shangqiu,Shangqiu 476000,Henan,China)
