作者：仇杰1，2 ，谢勇 2 ，李雨涵 2 ，徐超凡 2

单位：

1.225001 江苏省扬州市，扬州大学临床医学院；　2.225001 江苏省扬州市，江苏省苏北人民医院；通信作者：谢勇，E-mail：xieyong@medmail.com.cn

Units：

1.Clinical Medical College of Yangzhou University，Yangzhou 225001，China；2.Northern Jiangsu People's Hospital，Yangzhou 225001，China；Corresponding author：XIE Yong，E-mail：xieyong@medmail.com.cn

关键词：

前壁心肌梗死；ST 段抬高；Q 波总振幅与 R 波总振幅比值；主要不良心血管事件；预后；预测价值

Keywords：

Anterior wall myocardial infarction；ST-segment elevation；ΣQ/ΣR；Major adverse cardiovascularevent；Prognosis；Predictive value

CLC：

DOI：

Funds：

摘要：

背景　定量分析心电图 QRS 波群有利于预测急性 ST 段抬高型心肌梗死患者预后及筛查高危患者。目的　探讨入院时胸导联 Q 波总振幅与 R 波总振幅比值（ΣQ/ΣR）对急性 ST 段抬高型前壁心肌梗死患者急诊经皮冠状动脉介入治疗（PCI）后短期预后的预测价值。方法　选取 2017 年 1 月—2019 年 1 月于江苏省苏北人民医院行急诊PCI 的急性 ST 段抬高型前壁心肌梗死患者 201 例，根据入院时胸导联 ΣQ/ΣR 三分位数分为低 ΣQ/ΣR 组（n=67）、中 ΣQ/ΣR 组（n=67）和高 ΣQ/ΣR 组（n=67）。比较三组患者一般资料、实验室检查指标、PCI 情况、左心室射血分数（LVEF）、心电图检查结果及住院期间主要不良心血管事件（MACE）发生情况；入院时胸导联 Q 波总振幅（ΣQ）、R 波总振幅（ΣR）、ΣQ/ΣR 与急性 ST 段抬高型前壁心肌梗死患者症状发作至入院时间（SODT）、肌酸激酶同工酶（CK-MB）、PCI 后 24 h LVEF 及随访 3 个月 LVEF 的相关性分析采用 Spearman 秩相关分析；急性 ST 段抬高型前壁心肌梗死患者住院期间 MACE 的影响因素分析采用多因素 Logistic 回归分析；绘制 ROC 曲线以评价入院时胸导联 ΣQ/ΣR 对急性 ST 段抬高型前壁心肌梗死患者住院期间 MACE 的预测价值。结果　（1）三组患者年龄、高血压发生率、糖尿病发生率、吸烟率、丙氨酸氨基转移酶（ALT）、血肌酐、Na + 及行血栓抽吸术、右冠状动脉狭窄率>70%、PCI 后使用血管紧张素转换酶抑制剂（ACEI）、PCI 后使用 β- 受体阻滞剂者所占比例比较，差异无统计学意义（P>0.05）；三组患者男性比例、收缩压、心率、Killip 分级≥ 3 级者所占比例、SOTD、CK-MB、天冬氨酸氨基转移酶（AST）、K + 、无复流发生率、回旋支狭窄率 >70% 者所占比例、PCI 后 24 h LVEF、随访 3 个月 LVEF 及入院时胸导联 ΣQ、ΣR 比较，差异有统计学意义（P<0.01）。（2）高 ΣQ/ΣR 组患者住院期间 MACE 发生率高于低 ΣQ/ΣR 组、中 ΣQ/ΣR 组（P<0.05）。（3）Spearman 秩相关分析结果显示，入院时胸导联 ΣQ、ΣQ/ΣR 与急性 ST 段抬高型前壁心肌梗死患者 SODT、CK-MB 呈正相关，与 PCI 后 24 h LVEF、随访 3 个月 LVEF 呈负相关（P<0.01）；入院时胸导联 ΣR 与急性 ST 段抬高型前壁心肌梗死患者 SODT、CK-MB 呈负相关，与 PCI 后 24 h LVEF、随访 3 个月 LVEF 呈正相关（P<0.01）。（4）多因素 Logistic 回归分析结果显示，入院时胸导联 ΣQ/ΣR 是急性 ST 段抬高型前壁心肌梗死患者住院期间 MACE 的独立影响因素〔OR=1.115，95%CI（1.057，1.252），P<0.05〕。（5）入院时胸导联 ΣQ/ΣR 预测急性 ST 段抬高型前壁心肌梗死患者住院期间 MACE 的曲线下面积（AUC）为 0.789〔95%CI（0.721，0.858）〕，最佳截断值为 3.655，灵敏度为 0.661，特异度为 0.841。结论　入院时胸导联 ΣQ/ΣR 是急性 ST 段抬高型前壁心肌梗死患者急诊 PCI 后住院期间 MACE 的影响因素，且对患者住院期间 MACE 具有一定预测价值，可作为评估急性 ST 段抬高型前壁心肌梗死患者急诊 PCI 后短期预后的指标。

Abstract：

Background　Quantitative analysis of electrocardiographic QRS complex is helpful to evaluate theprognosis and screen high-risk patients with acute ST-segment elevation myocardial infarction. Objective　To investigatethe predictive value of chest lead ΣQ/ΣR at admission on short-term prognosis after emergency PCI in patients with acuteST-segment elevation anterior wall myocardial infarction. Methods　A total of 201 patients with acute ST-segment elevationanterior wall myocardial infarction were selected in Northern Jiangsu People's Hospital from January 2017 to January 2019，allof them underwent emergency PCI and were divided into A group（with low ΣQ/ΣR，n=67），B group（with medium ΣQ/ΣR，n=67）and C group（with high ΣQ/ΣR，n=67）according to the tertiles of chest lead ΣQ/ΣR at admission. Generalinformation，laboratory examination results，PCI related indicators，LVEF，electrocardiographic examination results andincidence of MACE during hospitalization were compared in the three groups；Spearman rank correlation analysis was used toanalyze the correlations of chest lead ΣQ，ΣR and ΣQ/ΣR at admission with symptom onset to admission time（SODT），CK-MB，LVEF 24 hours after PCI and 3 months after follow-up in patients with acute ST-segment elevation anterior wallmyocardial infarction；multivariate Logistic regression analysis was performed to identify the influencing factors of MACEduring hospitalization in patients with acute ST elevation anterior wall myocardial infarction；ROC curve was drawn to evaluatethe predictive value of chest lead ΣQ/ΣR at admission on MACE during hospitalization in patients with acute ST-segmentelevation anterior wall myocardial infarction. Results　（1）There was no statistically significant difference in age，incidence ofhypertension or diabetes，smoking rate，ALT，Scr，Na + ，proportion of patients underwent thrombus aspiration，with stenosisrate of right coronary artery>70%，using ACEI or β-receptor inhibitors after PCI in the three groups（P>0.05）；there wasstatistically significant difference in male proportion，SBP，heart rate，proportion of patients with Killip grade ≥ 3，SOTD，CK-MB，AST，K + ，incidence of no-reflow phenomenon，proportion of patients with stenosis rate of circumflex branch>70%，LVEF 24 hours after PCI and 3 months after follow-up，chest lead ΣQ andΣR at admission in the three groups，respectively（P<0.01）.（2）Incidence of MACE during hospitalization in C group was statistically significantly higher than that in groups Aand B，respectively（P<0.05）.（3）Spearman rank correlation analysis results showed that，chest lead ΣQ and ΣQ/ΣR atadmission was positively correlated with SODT and CK-MB in patients with acute ST-segment elevation anterior wall myocardialinfarction，respectively，but was negatively correlated with LVEF 24 hours after PCI and 3 months after follow-up，respectively（P<0.05）；chest lead ΣR at admission was negatively correlated with SODT and CK-MB in patients with acute ST-segmentelevation anterior wall myocardial infarction，respectively，but was positively correlated with LVEF 24 hours after PCI and 3months after follow-up（P<0.05）.（4）Multivariate Logistic regression analysis results showed that，chest lead ΣQ/ΣR atadmission was one of independent influencing factors of MACE during hospitalization in patients with acute ST-segment elevationanterior wall myocardial infarction〔OR=1.115，95%CI（1.057，1.252），P<0.05〕.（5）AUC，the optimal cut-offvalue，sensitivity and specificity of chest lead ΣQ/ΣR at admission in predicting MACE during hospitalization in patients withacute ST-segment elevation anterior wall myocardial infarction was 0.789〔95%CI（0.721，0.858）〕，3.655，0.661 and0.841，respectively. Conclusion　Chest lead ΣQ/ΣR at admission is one of influencing factors of MACE during hospitalizationin patients with acute ST-segment elevation anterior wall myocardial infarction who were treated by emergency PCI，which hascertain predictive value on MACE during hospitalization and is expected to be a indicator of short-term prognosis after emergencyPCI in patients with acute ST-segment elevation anterior wall myocardial infarction.

ReferenceList：