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急性心肌梗死QRS波终末变形与脑钠尿肽及临床预后的关系

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2010年第2期
页码:
193-196
栏目:
临床研究
出版日期:
2010-03-04

文章信息/Info

Title:
Relationship between terminal QRS distortion and brain natriuretic peptide and its prognostic significance in acute myocardial infarction
作者:
张莉; 何奔; 卜军; 丁嵩; 幺天保; 乔志卿
上海交通大学医学院附属仁济医院心内科，上海 200127
Author(s):
ZHANG Li;  HE Ben;  BO Jun;  DING Song;  YAO Tian-bao;  QIAO Zhi-qing
Department of Cardiology, Renji Hospital, Shanghai Jiaotong University, Shanghai 200127, China
关键词:
心肌梗死; 急性; 心电图QRS终末变形; 脑钠尿肽; 临床预后
Keywords:
myocardial infarction;  acute;  terminal QRS distortion;  brain natriuretic peptide;  prognosis
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的: 观察急性心肌梗死（AMI）患者心电图出现QRS复合波终末变形（terminal QRS distortion,TQRSD）的意义及其与血浆脑钠尿肽(brain natriuretic peptide,BNP)水平的关系。方法: 2005年1月～2006年11月AMI患者100例，记录并分析患者的首份心电图，分为TQRSD(+)和TQRSD(-)两组，测定患者症状发作后(27±11)h血浆BNP水平。随访患者1、3和6月病死率及主要心脏不良事件（MACE:心源性死亡、再发心肌梗死、再发心绞痛、继发心力衰竭和再入院的复合终点）发生率。结果: 血浆BNP水平在TQRSD(+)组显著高于TQRSD(-)组（P<0.01）。多变量的Logistic回归分析示BNP独立于各因素可预测1、3和6月 MACE的发生率及1月病死率。TQRSD独立于各因素，预测1、3和6月MACE的发生率，但在预测1月病死率模型中无意义。将BNP及TQRSD和年龄、性别、家族史、吸烟、高胆固醇血症、高血压病、糖尿病、前壁心梗、急诊行PCI、Killip分级≥II级、CPK酶峰、LVEF、E/A等因素放入同一模型预测AMI的1、3、6月MACE发生率。多变量的Logistic回归分析显示TQRSD在此模型中失去了预测效能，BNP独立于各因素可预测1、3、6月MACE发生率。结论: TQRSD(+)患者血浆BNP水平较高。TQRSD和BNP能预测短期MACE发生率，BNP能预测短期病死率。与TQRSD相比，BNP预测AMI患者近期的临床预后价值更大。
Abstract:
AIM: To investigate the prognostic significance of terminal QRS distortion (TQRSD) and the relationship between TQRSD and brain natriuretic peptide (BNP) in acute myocardial infarction (AMI). METHODS: The study population consisted of 100 consecutive patients with AMI and was carried out between January 2005 and November 2006. The initial electrocardiogram of the 100 cases with AMI was divided into two groups according to the status of terminal QRS distortion: TQRSD(+) or TQRSD(-). Plasma BNP levels of the 100 cases with AMI were measured by immunoassay at (27±11) h after symptom onset. The incidence of major cardiac events(MACE) and mortality was assessed during a period of 6 months. RESULTS: TQRSD(+) group had higher concentration of plasma BNP (P<0.01). Multiple logistic regression analysis showed that BNP was independently associated with 30-day, 3-month and 6-month incidence of MACE and 30 day mortality. TQRSD was independently associated with 30 day, 3-month and 6-month incidence of MACE. However, TQRSD lost its predictive value after BNP was introduced into the model. CONCLUSION: Patients with TQRSD(+) have higher concentrations of plasma BNP. BNP is independently associated with short-term incidence of MACE and mortality. TQRSD is independently associated with short-term incidence of MACE.

参考文献/References

［1］ Tamura A, Nagase K, Watanabe T, et al. Relationship between terminal QRS distortion on the admission electrocardiogram and the time course of left ventricular wall motion in anterior wall acute myocardial infarction［J］. Jpn Circ J, 2001, 65(2):63-66.

［2］ Sejersten M, Birnbaum Y, Ripa RS, et al. Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percutaneous coronary intervention: results from the DANAMI-2 trial［J］. Heart, 2006, 92(11):1577-1582.

［3］ Richards AM, Nicholls MG, Espiner EA, et al. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction［J］. Circulation, 2003, 107(22):2786-2792.

［4］ Suzuki S, Yoshimura M, Nakayama M, et al. Plasma level of B-type natriuretic peptide as a prognostic market after acute myocardial infarction:a long term follow-up analyse［J］. Circulation, 2004, 110(11):1387-1391.

［5］ 何奔，丁嵩，卜军,等. 脑利钠肽和C反应蛋白在急性冠状动脉综合症介入治疗患者的预后价值［J］. 中华心血管病杂志， 2006 ，34（4）：349-352.

［6］ Asada J, Tsuji H, Iwasaka T, et al. Usefulness of plasma brain natriuretic peptide levels in predicting dobutamine-induced myocardial ischemia［J］. Am J Cardiol, 2004, 93(6):702-704.

［7］丁嵩，何奔，孙瑜,等. 急性心肌梗死PCI术后心肌血流再灌注水平与脑钠肽的关系［J］. 中国介入心血管病杂志, 2006， 14（4）：218-221.

［8］ Lee CW, Hong MK, Yang HS, et al. Determinants and prognostic implications of terminal QRS complex distortion in patients treated with primary angioplasty for acute myocardial infarction［J］. Am J Cardiol, 2001, 88(3):210-213.

［9］ Mager A, Sclarovsky S, Herz I, et al. QRS complex distortion predicts no reflow after emergency angioplasty in patients with acute myocardial infarction［J］. Coron Artery Dis, 1998, 9(4):199-205.

备注/Memo

备注/Memo:
收稿日期：2008-5-28.基金项目：浦东新区社发局协作课题项目资助(PW050432) 通讯作者：何奔，主任医师，主要从事冠脉介入治疗及研究Email:heben@hotmail.com 作者简介：张莉，住院医师，硕士Email:missekg@sina.com
更新日期/Last Update: 2010-03-05