QT离散度预测老年急性心肌梗死患者室性心律失常的价值分析
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摘要
目的:探究QT间期离散度(QTd)预测老年急性心肌梗死(AMI)患者发生室性心律失常的临床价值。方法:回顾性分析2017年1月至2018年1月博罗县人民医院收治的150例老年AMI患者的资料,依据患者入院后心律失常发生情况分为恶性室性心律失常组(A组,n=42)、潜在恶性室性心律失常组(B组,n=60)和无室性心律失常组(C组,n=48),分析QTd与老年AMI患者心律失常发生的关系,观察QTd取不同截断值时对心律失常预测的价值。结果:各组间QTd和校正QTd(QTcd)水平相比,差异均有统计学意义(P<0.05)。组间两两比较差异均有统计学意义(P<0.05),且QTd和QTcd水平A组>B组>C组。QTd截断值取60 ms是最佳截断值,对AMI患者心律失常预测的灵敏度、特异度分别为90.51%、83.19%,约登指数为0.7370。结论:老年AMI患者QTd、QTcd越高则室性心律失常发生风险越大,当QTd截断值取60 ms时对老年AMI患者室性心律失常具有较好的预测价值。
Objective: to explore the clinical value of QT interval dispersion(QTd) in predicting ventricular arrhythmia in elderly patients with acute myocardial infarction(AMI). Methods: The clinical data of one hundred and fifty elderly patients with AMI admitted to Boluo County People's Hospital from January 2017 to January 2018 were analyzed retrospectively. Patients were divided into malignant ventricular arrhythmia group(group A, n=42 cases), potential malignant ventricular arrhythmia group(group B, n=60 cases) and non-ventricular arrhythmia group(group C, n=48 cases) according to the occurrence of arrhythmia. The relationship was analyzed between QTd and arrhythmia in elderly patients with AMI, The value of different truncated values of QTd in predicting arrhythmia was observed. Results: There was significant difference for QTd and corrected QTcd among the three groups(P<0.05), with significant difference between every two groups(P<0.05), group A>group B> group C for the levels of QTd and QTcd. The best cut-off value was 60 ms for QTd. The sensitivity and specificity for predicting arrhythmia in patients with AMI were 90.51% and 83.19% respectively. The Yoden index was 0.7370.Conclusion: The higher the level of QTd and QTcd, the higher the risk of ventricular arrhythmia in elderly patients with AMI. When the cut-off value of QTd is 60 ms, it has better predictive value for ventricular arrhythmia in elderly patients with AMI.
Objective: to explore the clinical value of QT interval dispersion(QTd) in predicting ventricular arrhythmia in elderly patients with acute myocardial infarction(AMI). Methods: The clinical data of one hundred and fifty elderly patients with AMI admitted to Boluo County People's Hospital from January 2017 to January 2018 were analyzed retrospectively. Patients were divided into malignant ventricular arrhythmia group(group A, n=42 cases), potential malignant ventricular arrhythmia group(group B, n=60 cases) and non-ventricular arrhythmia group(group C, n=48 cases) according to the occurrence of arrhythmia. The relationship was analyzed between QTd and arrhythmia in elderly patients with AMI, The value of different truncated values of QTd in predicting arrhythmia was observed. Results: There was significant difference for QTd and corrected QTcd among the three groups(P<0.05), with significant difference between every two groups(P<0.05), group A>group B> group C for the levels of QTd and QTcd. The best cut-off value was 60 ms for QTd. The sensitivity and specificity for predicting arrhythmia in patients with AMI were 90.51% and 83.19% respectively. The Yoden index was 0.7370.Conclusion: The higher the level of QTd and QTcd, the higher the risk of ventricular arrhythmia in elderly patients with AMI. When the cut-off value of QTd is 60 ms, it has better predictive value for ventricular arrhythmia in elderly patients with AMI.
引文
[1]Saya S,Hennebry TA,Lozano P,et al.Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias:a case report and review of literature.Clin Cardiol,2008,31(8):352-355.
[2]Ueda H,Hayashi T,Tsumura K,et al.QT dispersion and prognosis after coronary stent placement in acute myocardial infarction.Clin Cardio,2007,30(5):229-233.
[3]罗进,罗义.不同再灌注时间窗对急性心肌梗死患者Tp-e、Tp-e/QT及室性心律失常的影响.岭南心血管病杂志,2015,21(3):321-325.
[4]黄宇理,李妙男,徐玮,等.QT离散度预测老年急性心肌梗死患者发生室性心律失常的临床价值.中华全科医学,2014,12(3):382-383.
[5]苗磊,刘培良.老年AMI病人QT离散度变化的临床观察.中国保健营养(中旬刊),2014,24(2):535.
[6]任颖,张虹,赵静惠.急性心梗的诊断和治疗.天津:天津科学技术出版社,2012:232-235.
[7]赵艳辉,朱智明,高连如,等.ST段抬高型心肌梗死再灌注心律失常患者主要心血管事件的观察研究.中国急救复苏与灾害医学杂志,2016,11(6):577-581.
[8]苏懿,王磊,张敏州.急性心肌梗死的流行病学研究进展.中西医结合心脑血管病杂志,2012,10(4):467-469.
[9]于立鹏,杨志明.急性心肌梗死后缺血再灌注性心律失常发病机制及预防的研究进展.实用医学杂志,2016,32(9):1536-1537.
[10]王印华,王宝华,白静,等.缺血后适应对急性心肌梗死患者再灌注心律失常及心肌损伤的影响.中国循证心血管医学杂志,2014,6(2):153-155,159.
[11]常娟,李学文.心室复极指标在预测急性心肌梗死恶性室性心律失常中的临床价值分析.中国卫生标准管理,2016,7(4):36-37.
[12]王超豪.QT离散度在急性冠脉综合征中的临床意义及PCI术后QT离散度的变化研究[D].安徽医科大学,2014.
[13]赵妍,马向红,李广平.Tp-e/QT比值和QTd对急性ST段抬高性心肌梗死患者室性心律失常的预测价值.中华临床医师杂志(电子版),2013,7(2):504-507.
[14]卢小伟.QT离散度、T波峰末间期及血清结缔组织生长因子水平对冠心病恶性心律失常的诊断价值分析.实用心脑肺血管病杂志,2017,25(11):59-62.
[15]Ornek E,Duran M,Ornek D,et al.The effect of thrombolytic therapy on QT dispersion in acute myocardial infarction and its role in the prediction of reperfusion arrhythmias.Niger JClin Pract,2014,17(2):183-187.
[16]刘小华,黄健芬,胡新科,等.急性冠脉综合症未行急性PCI患者QT离散度在预测室性心律失常的临床分析及应用价值.中国继续医学教育,2015,7(31):88-89.
[17]杨艳芳,陈素.AMI患者QTd、Tp-e和Tp-e/QT的临床意义.新医学,2014,45(2):116-118.
[2]Ueda H,Hayashi T,Tsumura K,et al.QT dispersion and prognosis after coronary stent placement in acute myocardial infarction.Clin Cardio,2007,30(5):229-233.
[3]罗进,罗义.不同再灌注时间窗对急性心肌梗死患者Tp-e、Tp-e/QT及室性心律失常的影响.岭南心血管病杂志,2015,21(3):321-325.
[4]黄宇理,李妙男,徐玮,等.QT离散度预测老年急性心肌梗死患者发生室性心律失常的临床价值.中华全科医学,2014,12(3):382-383.
[5]苗磊,刘培良.老年AMI病人QT离散度变化的临床观察.中国保健营养(中旬刊),2014,24(2):535.
[6]任颖,张虹,赵静惠.急性心梗的诊断和治疗.天津:天津科学技术出版社,2012:232-235.
[7]赵艳辉,朱智明,高连如,等.ST段抬高型心肌梗死再灌注心律失常患者主要心血管事件的观察研究.中国急救复苏与灾害医学杂志,2016,11(6):577-581.
[8]苏懿,王磊,张敏州.急性心肌梗死的流行病学研究进展.中西医结合心脑血管病杂志,2012,10(4):467-469.
[9]于立鹏,杨志明.急性心肌梗死后缺血再灌注性心律失常发病机制及预防的研究进展.实用医学杂志,2016,32(9):1536-1537.
[10]王印华,王宝华,白静,等.缺血后适应对急性心肌梗死患者再灌注心律失常及心肌损伤的影响.中国循证心血管医学杂志,2014,6(2):153-155,159.
[11]常娟,李学文.心室复极指标在预测急性心肌梗死恶性室性心律失常中的临床价值分析.中国卫生标准管理,2016,7(4):36-37.
[12]王超豪.QT离散度在急性冠脉综合征中的临床意义及PCI术后QT离散度的变化研究[D].安徽医科大学,2014.
[13]赵妍,马向红,李广平.Tp-e/QT比值和QTd对急性ST段抬高性心肌梗死患者室性心律失常的预测价值.中华临床医师杂志(电子版),2013,7(2):504-507.
[14]卢小伟.QT离散度、T波峰末间期及血清结缔组织生长因子水平对冠心病恶性心律失常的诊断价值分析.实用心脑肺血管病杂志,2017,25(11):59-62.
[15]Ornek E,Duran M,Ornek D,et al.The effect of thrombolytic therapy on QT dispersion in acute myocardial infarction and its role in the prediction of reperfusion arrhythmias.Niger JClin Pract,2014,17(2):183-187.
[16]刘小华,黄健芬,胡新科,等.急性冠脉综合症未行急性PCI患者QT离散度在预测室性心律失常的临床分析及应用价值.中国继续医学教育,2015,7(31):88-89.
[17]杨艳芳,陈素.AMI患者QTd、Tp-e和Tp-e/QT的临床意义.新医学,2014,45(2):116-118.
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