天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (5): 406-410.doi: 10.11958/20200112

• 临床研究 • 上一篇    下一篇

碎裂QRS波与非ST段抬高型急性心肌梗死患者冠状动脉病变及左室功能的关系 #br#

徐艳玲，余意君，顾力，吴慧君，郑伟，周志云，顾晔△   

  1. 武汉市第四医院，华中科技大学同济医学院附属普爱医院（邮编430033）

  • 收稿日期:2020-01-10 修回日期:2020-03-13 出版日期:2020-05-15 发布日期:2020-06-24
  • 通讯作者: 顾晔 E-mail:yegu2003m@163.com
  • 作者简介:徐艳玲（1983），女，主治医师，硕士，主要从事心电生理学方面研究
  • 基金资助:
    武汉市卫计委科研资助项目（WX18Q36）

Relationship between coronary lesion and left ventricular function in patients with fragmented QRS and non-ST elevation acute myocardial infarction #br#

XU Yan-ling, YU Yi-jun, GU Li, WU Hui-jun, ZHENG Wei, ZHOU Zhi-yun, GU Ye△ #br#   

  1. Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
  • Received:2020-01-10 Revised:2020-03-13 Published:2020-05-15 Online:2020-06-24

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摘要： 摘要：目的 探讨非ST段抬高型急性心肌梗死（NSTEAMI）患者碎裂QRS波（fQRS）与冠状动脉病变程度及左室
功能的相关性。方法 回顾性分析我院心内科住院的行冠脉造影术的 NSTEAMI患者 183例，根据心电图上是否存
在fQRS（相邻2个及以上导联）分为nfQRS组99例和fQRS组84例。比较2组患者临床基本特征、冠脉造影资料以及
超声心动图等差异。结果 与 nfQRS组相比，fQRS组肌钙蛋白 I （cTnI）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、
乳酸脱氢酶（LDH）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、血肌酐（Scr）、超敏反应 C蛋白
（hs-CRP）等明显升高（P＜0.05）；fQRS 组患者 Gensini 评分、N端脑利钠肽前体（NT-proBNP）值明显高于 nfQRS 组，
LVEF 明显低于 nfQRS 组（P＜0.01）。Logistic 回归分析显示，cTnI、CK-MB、Gensini 评分升高以及 LVEF 降低是
NSTEAMI患者发生 fQRS的危险因素。根据 fQRS出现的导联数分为 2个亚组，导联数 > 3组的 Gensini评分、冠脉病
变≥3支的比例均显著高于导联数≤3组。结论 心电图上存在fQRS的NSTEAMI患者，尤其是fQRS出现导联数越多
者，冠脉病变更重，左室功能更差，心肌缺血更严重。

关键词: 非ST段抬高型急性心肌梗死, 碎裂QRS波, 冠脉造影, Gensini评分, 左室射血分数

Abstract: Abstract: Objective To investigate the relationship between the fragmented QRS (fQRS) and the degree of coronary
artery lesion and left ventricular function in patients with non-ST elevation acute myocardial infarction (NSTEAMI).
Methods Data of 183 patients with NSTEAMI who underwent coronary angiography in the department of cardiology of our
hospital from January 2018 to October 2019 were retrospectively analyzed. According to the presence of fQRS (two or more
adjacent leads) on the resting ECG, patients were divided into fQRS group (n=84) and nfQRS group (n=99). The clinical
characteristics, coronary angiography data and echocardiography were analyzed between the two groups. Results The blood
biochemical indexes such as cTnI, CK, CK-MB, LDH, TC, TG, LDL-C, Scr and hs-CRP were significantly increased in
fQRS group compared to those of nfQRS group (P＜0.05). Gensini score and NT-proBNP value were significantly higher,
LVEF was significantly lower, in fQRS group than those in nfQRS group (P＜0.01). Logistic regression analysis showed that
the higher cTnI, CK-MB and Gensini score, and the lower LVEF were risk factors for fQRS in NSTEAMI patients. The fQRS
group was then divided into two subgroups. The Gensini score of the lead number > 3 and the proportion of coronary artery
lesion＞3 were significantly higher than those with the lead number≤3 group. Conclusion For NSTEAMI patients with
fQRS on the ECG, especially those with more leads of fQRS, the coronary artery lesion is more serious, the left ventricular
function is worse and myocardial ischemia is more severe.

Key words: non-ST elevation acute myocardial infarction, fragmented QRS, coronary angiography, Gensini score, left ventricular ejection fraction

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