Tp-ed对变异型心绞痛发生恶性室性心律失常的预测价值

发布时间：2018-02-25 17:23

本文关键词： 变异型心绞痛 Tp-e 离散度恶性室性心律失常　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景及目的:恶性心律失常,作为冠心病导致猝死的重要因素一直备受广大临床医生和研究者所关注,特别是在急性心肌梗死、变异型心绞痛(variant angina pectoris,VAP)的患者中,恶性心律失常的发生率尤为突出。既往研究资料显示:冠脉痉挛病人室性恶性心律失常的发生率为5%-15%,而严重心律失常可致猝死。研究发现VAP病人中与没有发生心跳骤停、晕厥等恶性事件的人群相比,发生发生心跳骤停或晕厥的QT离散度明显增大,这表明VAP患者可能存在异常的心室复极离散度,导致发生恶性心律失常事件(malignant ventricular arrhythmia events,MVAE)风险增加。但有研究表明QT离散度并不能直接反映心室复极离散度,并不是一个可靠的反映心室复极离散度的指标。越来越多的基础和临床研究表明,增大的Tp-e间期(心电图上T波的顶点到终点的距离,Tpeak-Tend interval)与恶性室性心律失常的发生有关。Tp-e和Tp-e/QT这些指标近年一直在进行临床研究并用于预测恶性心律失常的发生,而对Tp-e离散度(Tp-ed)研究较少。上述这些指标在VAP患者发作时的变化及其对MVAE的预测价值报道尚无。本研究通过对变异型心绞痛患者发作时QT间期、校正QT间期(corrected Tp-e interval,c QT)、Tp-e间期,校正Tp-e间期(corrected Tp-e interval,c Tp-e)、Tp-e/QT比值、Tp-e离散度(Tp-e interval dispersion,Tp-ed)、校正Tp-e离散度(corrected Tp-e interval dispersion,c Tp-ed)和Tp-ed/QT比值的测算,评价其对恶性心律失常事件的预测价值。方法:选取郑州大学人民医院住院或门诊就诊的变异型心绞痛患者,50例单纯VAP患者和23例VAP合并MVAE的患者入选本研究。VAP发作时并发MVAE为观察组;VAP发作时未并发MVAE为对照组。使用t检验、logistic回归分析和受试者工作曲线(receiver operating characteristic curve,ROC)分析ST段抬高时期心电图参数和MVAE(室性心动过速/心室颤动、晕厥和成功复苏的心源性猝死)发生的关系。结果:1.观察组(VAP发作时并发MVAE)与对照组(VAP发作时未并发MVAE)之间年龄、性别等一般资料差异无明显统计学意义。2.VAP发作时并发MVAE组比VAP发作时未并发MVAE组有更长的QT间期(424.26±72.55vs385.62±38.97;P=0.04)、Tp-e间期(141.48±45.15 vs 104.00±14.80;P0.001)、c Tp-e(142.22±41.74 vs 112.75±20.44;P=0.001)、Tp-ed(66.04±38.46 vs 27.30±14.11;P0.001)、c Tp-ed(65.90±36.86vs29.49±15.13;P0.001)和更大的Tp-e/QT比值(0.334±0.087 vs 0.271±0.042;P=0.001)、Tp-ed/QT比值(0.153±0.071 vs 0.071±0.035;P0.001)。3.单因素回归分析显示QT比值比(odds ratio,OR)=1.014;95%可信区间(confidence intervals,CI)1.003-1.025;P=0.011)、Tp-e间期(OR=1.083;95%CI 1.037-1.131;P0.001)、c Tp-e(OR=1.040;95%CI 1.014-1.066;P0.001)、Tp-e/QT比值(OR=1.018;95%CI1.007-1.030;P=0.002)、Tp-ed(OR=1.114;95%CI 1.058-1.173;P0.001)、c Tp-ed(OR=1.108;95%CI 1.054-1.164;P0.001)和Tp-ed/QT(OR=1.045;95%CI 1.023-1.068;P0.001)均显示与MVAE的发作有关。多因素逐步回归分析显示,只有Tp-ed/QT可以进入回归方程作为预测因子。4.ROC曲线下面积(area under curve,AUC)QT为0.653、Tp-e间期为0.847、c Tp-e为0.752、Tp-e/QT为0.736、Tp-ed为0.893、c Tp-ed为0.886、Tp-ed/QT为0.883(均P0.05)。Z检验显示Tp-ed、c Tp-ed的AUC与QT、Tp-e间期、c Tp-e、Tp-e/QT比值的AUC相比均有显著差异(均P0.05),Tp-ed/QT比值的AUC与QT、c Tp-e、Tp-e/QT比值的AUC相比均有显著差异(均P0.05),Tp-e比值的AUC与Tp-e/QT、QT的AUC相比均有显著差异(均P0.05)。结论:QT在合并MVAE的VAP患者中明显增高,但其预测MVAE的发生的价值有限;Tp-e、c Tp-e、Tp-e/QT、Tp-ed、c Tp-ed和Tp-ed/QT在合并MVAE的VAP患者中明显增高,均可预测MVAE的发生。Tp-ed是最敏感的预测因子。Tp-ed可能是反映整体复极离散度的更有价值的心电图参数。
[Abstract]:Background and objective: malignant arrhythmia, coronary heart disease is an important factor leading to sudden death has always been the majority of clinicians and researchers concerned, especially in patients with acute myocardial infarction, angina pectoris (variant angina, pectoris, VAP) in patients with malignant arrhythmia is particularly prominent. The previous research data showed that patients with coronary spasm ventricular arrhythmia incidence rate was 5%-15%, which can cause severe arrhythmia and sudden cardiac death. VAP was found in patients with and without cardiac arrest, compared with syncope and malignant events crowd, occurrence of syncope or cardiac arrest have QT dispersion significantly increased, suggesting that VAP patients may have abnormal ventricular repolarization. Lead to the occurrence of malignant arrhythmia events (malignant ventricular arrhythmia events, MVAE) increased risk. But studies have shown that the QT dispersion does not directly reflect the ventricle Dispersion of repolarization, and not a reliable reflection of ventricular repolarization dispersion index. More and more basic and clinical research shows that the increase of the Tp-e interval (range, T wave peak to the end point of electrocardiographic Tpeak-Tend interval and Tp-e/QT.Tp-e) with these indicators in recent years has been engaged in clinical research and for predicting malignant arrhythmia the occurrence of arrhythmia and malignant ventricular arrhythmias, and the dispersion of Tp-e (Tp-ed) research. These changes in indicators in VAP patients during the attack and prediction of the value of the MVAE have not been reported. This study based on the onset of patients with variant angina QT interval, corrected QT interval (corrected Tp-e interval. C QT), Tp-e interval, corrected Tp-e interval (corrected Tp-e interval, C Tp-e), Tp-e/QT ratio, Tp-e dispersion (Tp-e interval dispersion, Tp-ed), corrected Tp-e (corrected Tp-e dispersion interval dis Persion, C Tp-ed) and Tp-ed/QT ratio calculation, the evaluation of the predictive value of malignant arrhythmia. Methods: select Zhengzhou University people's hospital inpatient or outpatient treatment in patients with variant angina, 50 cases of VAP patients and 23 VAP patients with MVAE were enrolled in this study of.VAP attack with MVAE as the observation group VAP attack; not with MVAE as the control group. Using t test, logistic regression analysis and receiver operating curve (receiver operating characteristic curve, ROC) of ST elevation and MVAE period of ECG parameters (ventricular tachycardia and ventricular fibrillation, cardiac syncope and successful resuscitation of sudden death) occurred. Results: the observation group (1. VAP attack with MVAE) and control group (VAP attack without concurrent MVAE) between age, gender and other demographic data showed no statistically significant differences between the onset of.2.VAP complicated with MVAE group than in the VAP attack is not Concurrent MVAE group had a longer QT interval (424.26 + 72.55vs385.62 + 38.97; P=0.04), Tp-e interval (141.48 + 45.15 vs 104 + 14.80; P0.001), C Tp-e (142.22 + 41.74 vs 112.75 + 20.44; P=0.001), Tp-ed (66.04 + 38.46 vs 27.30 + 14.11; P0.001), C Tp-ed (65.90. 36.86vs29.49 + 15.13; P0.001) and Tp-e/QT ratio were greater (0.334 + 0.087 vs 0.271 + 0.042; P=0.001), the ratio of Tp-ed/QT (0.153 + 0.071 vs 0.071 + 0.035; P0.001).3. single factor regression analysis showed that the ratio of QT (odds ratio, OR =1.014); 95% confidence interval (confidence intervals, CI 1.003-1.025); P=0.011), Tp-e interval (OR=1.083; 95%CI 1.037-1.131; P0.001), C Tp-e (OR=1.040; 95%CI 1.014-1.066; P0.001), the ratio of Tp-e/QT (OR=1.018; 95%CI1.007-1.030; P=0.002), Tp-ed (OR=1.114; 95%CI 1.058-1.173; P0.001), C Tp-ed (OR=1.108; 95%CI 1.054-1.164; P0.001) and Tp-ed/QT (OR=1.045; 95%CI 1.023-1.06 8; P0.001) were associated with the onset of MVAE. Multiple stepwise regression analysis showed that only Tp-ed/QT can enter the regression equation as the predictive factor of area under the curve of.4.ROC (area under curve, AUC) QT 0.653, Tp-e interval was 0.847, C Tp-e 0.752, Tp-e/QT 0.736, Tp-ed 0.893, C Tp-ed 0.886, Tp-ed/QT was 0.883 (P0.05).Z test showed that Tp-ed, AUC and QT, C Tp-ed, C Tp-e, Tp-e interval, significant differences between the Tp-e/QT ratio AUC were compared (P0.05), AUC and QT, the ratio of Tp-ed/QT C Tp-e, the ratio of Tp-e/QT compared to AUC were significant difference (P0.05). AUC and Tp-e/QT Tp-e ratio, QT AUC showed a significant difference (P0.05). Conclusion: QT and MVAE increased significantly in VAP patients, but its limited value in predicting the occurrence of MVAE C Tp-e, Tp-e/QT; Tp-e, Tp-ed, C Tp-ed and Tp-ed/ QT increased significantly in patients with MVAE VAP that can predict MV The occurrence of.Tp-ed in AE is the most sensitive predictor of.Tp-ed, which may be a more valuable electrocardiogram parameter reflecting the overall repolarization dispersion.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541

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