摘要
目的:探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者碎裂QRS波(fragmented QRS complex,fQRS)与心脏自主神经功能及左室重构的相关性。方法:回顾性分析华中科技大学同济医学院附属普爱医院心内科住院的STEMI患者170例,根据心电图上是否存在fQRS分为nfQRS组94例和fQRS组76例。分析患者基本临床资料、24 h动态心电图指标及超声心动图数据等,比较2组患者之间的差异。结果:与nfQRS组相比,fQRS组心率变异性(heart rate variability,HRV)指标24 h正常窦性R-R间期标准差(standard deviation of NN intervals,SDNN)、24 h内每5min窦性R-R间期均值标准差(standard deviation of all 5-min average NN intervals,SDANN)、极低频(very low frequency,VLF)、低频(low frequency,LF)、低频与高频功率比值(ratio of low frequency to high frequency power,LF/HF)明显降低(P<0.05);左室功能指标左室射血分数(left ventricular ejection fraction,LVEF)明显低于nfQRS组,而左室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)、N-端脑钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)明显高于nfQRS组(P<0.01)。多因素logistic回归分析,经校正年龄、性别后,SDNN、SDANN、VLF、LF、LF/HF、LVEF降低及NT-proBNP升高是STEMI患者发生fQRS的危险因素。Spearman相关分析显示,STEMI患者SDNN、SDANN、VLF、LF、LF/HF、LVEF与fQRS呈显著负相关,而LVEDD、NT-proBNP与fQRS呈显著正相关(P<0.01)。结论:心电图上存在fQRS的STEMI患者,心肌缺血较严重,心脏自主神经功能损伤明显,左室重构显著。
Objective:To investigate the association of fragmented QRS complex(fQRS)with cardiac autonomic nerve function and left ventricular remodeling in patients with acute ST-segment elevation myocardial infarction(STEMI). Methods:A retrospective analysis was performed on 170 STEMI patients hospitalized in the cardiology department of our hospital. According to the presence of fQRS on the ECG,patients were divided into nfQRS group(n=94)and fQRS group(n=76). Basic clinical data,24 h dynamic ECG indicators and echocardiography data were analyzed to compare the differences between the patients of the two groups. Results:Compared with the nfQRS group,the values of standard deviation of NN intervals(SDNN),standard deviation of all 5-min average NN intervals(SDANN),very low frequency(VLF),low frequency(LF),ratio of low frequency to high frequency power(LF/HF)of heart rate variability(HRV)in the f QRS group were significantly decreased(P<0.05);the left ventricular ejection fraction(LVEF)of left ventricular function of the f QRS group was significantly lower than that of the nf QRS group,while the left ventricular end-diastolic dimension(LVEDD)and N-terminal pro brain natriuretic peptide(NT-pro BNP) values were significantly higher than those of nf QRS group(P <0.01). Multiple logistic regression analysis showed that after adjusting for age and gender,reduced SDNN,SDANN,VLF,LF,LF/HF,LVEF and increased NT-pro BNP were risk factors for f QRS in STEMI patients. Spearman correlation analysis showed that SDNN,SDANN,VLF,LF,LF/HF,LVEF were significantly negatively correlated with f QRS in STEMI patients,while LVEDD,NT-pro BNP were significantly positively correlated with f QRS(P<0.01). Conclusion:In STEMI patients with f QRS on ECG,myocardial ischemia is serious,cardiac autonomic nerve function damage is obvious,and left ventricular remodeling is significant.
作者
徐艳玲
余意君
顾力
吴慧君
郑伟
周志云
Xu Yanling;Yu Yijun;Gu Li;Wu Huijun;Zheng Wei;Zhou Zhiynn(Department of Electrop hys iology,Wuhan Fourth Hospital,Puai Hospital,Tongji Medical College of Huazhong University of Science and Technology)
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2021年第8期947-952,共6页
Journal of Chongqing Medical University
基金
武汉市卫计委科研基金资助项目(编号:WX18Q36)。
关键词
急性ST段抬高型心肌梗死
碎裂QRS波
心率变异性
左室射血分数
ST-segment elevation myocardial infarction
fragmented QRS complex
heart rate variability
left ventricular ejection fraction