2021 年第 1 期 第 16 卷

校正后Tp-Te间期和校正后QT间期及Tp-Te/QT比值对急性ST段抬高型心肌梗死患者溶栓治疗后恶性心律失常及不良预后的预测价值

Predictive value of adjusted Tp-Te interval, adjusted QT interval and Tp-Te/QT ratio in malignant arrhythmia and poor prognosis in patients with acute ST-segment elevation myocardial infarction after thrombolytic therapy

作者：张美婷刘宏汤日宁

英文作者：Zhang Meiting Liu Hong Tang Rining

单位：辽宁省葫芦岛市中心医院功能科125001

英文单位：Department of Function Huludao Central Hospital Liaoning Province Huludao 125001 China

关键词：急性ST段抬高型心肌梗死；恶性心律失常；心电图；预测价值

英文关键词：AcuteST-segmentelevationmyocardialinfarction;Malignant 

• 摘要：

• 目的 探讨校正后Tp-Te间期（Tp-Tec）、校正后QT间期（QTc）、Tp-Te/QT比值在早期评估急性ST段抬高型心肌梗死（STEMI）患者溶栓治疗后恶性心律失常及不良预后中的应用价值。方法 收集2016年7月至2019年11月辽宁省葫芦岛市中心医院收治的103例接受阿替普酶溶栓治疗的急性STEMI患者的临床资料。根据患者溶栓后24 h内是否发生恶性心律失常分为恶性心律失常组（30例）和对照组（73例），并根据患者溶栓后30 d内是否死亡分为死亡组（9例）和存活组（94例）。根据患者发病3 h内第1份心电图资料，比较恶性心律失常组和对照组Tp-Tec、QTc、Tp-Te/QT比值；绘制受试者工作特征（ROC）曲线，分析Tp-Tec、QTc、Tp-Te/QT比值对患者溶栓治疗后恶性心律失常及不良预后的预测价值。结果 恶性心律失常组Tp-Tec、QTc、Tp-Te/QT比值均高于对照组［（128±8）ms比（123±8）ms、（438±13）ms比（430±14）ms、（0.31±0.05）比（0.23±0.04）］，差异均有统计学意义（均P＜0.05）。死亡组Tp-Tec、QTc、Tp-Te/QT比值均高于存活组［（131±9）ms比（122±9）ms、（452±11）ms比（434±11）ms、（0.27±0.06）比（0.22±0.05）］，差异均有统计学意义（均P＜0.05）。ROC曲线分析结果显示，Tp-Te/QT比值预测急性STEMI患者溶栓后恶性心律失常的曲线下面积高于Tp-Tec和QTc（0.884比0.605、0.773）。Tp-Tec的截点值为124.22 ms，QTc的截点值为440.60 ms，Tp-Te/QT比值的截点值为0.29。Tp-Te/QT比值的预测敏感度为80.00%，特异度为89.04%。结论 Tp-Tec、QTc、Tp-Te/QT比值均有助于早期预测急性STEMI患者溶栓后恶性心律失常的发生，其中以Tp-Te/QT比值预测价值最高。三者均与不良预后存在一定关联，有助于临床医师早期评估患者预后，针对性地采取措施。

• Objective To explore the value of adjusted Tp-Te interval(Tp-Tec), adjusted QT interval(QTc), Tp-Te/QT ratio in the early evaluation of malignant arrhythmia and poor prognosis after thrombolysis in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods The clinical data of 103 patients with acute STEMI who underwent thrombolysis with alteplase in Huludao Central Hospital, Liaoning Province from July 2016 to November 2019 were selected. According to whether the patients with malignant arrhythmia occurrence within 24 h after thrombolysis, they were divided into malignant arrhythmia group (30 cases) and control group (73 cases), and divided into death group (9 cases) and survival group (94 cases) according to the mortality within 30 d after thrombolysis. According to the first electrocardiogram data within 3 h after onset of malignant arrhythmia, Tp-Tec, QTc, Tp-Te/QT ratio were compared between malignant arrhythmia group and control group. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of Tp-Tec, QTc and Tp-Te/QT ratio in early evaluation of malignant arrhythmia after thrombolytic. Results The Tp-Tec, QTc, Tp-Te/QT ratio of the malignant arrhythmia group were higher than those of the control group［（128±8）ms vs （123±8）ms, （438±13）ms vs （430±14）ms, （0.31±0.05） vs （0.23±0.04）］(all P＜0.05). The Tp-Tec, QTc, Tp-Te / QT ratio of the death group were higher than those of the survival group［（131±9）ms vs （122±9）ms, （452±11）ms vs （434±11）ms, （0.27±0.06） vs （0.22±0.05）］(all P＜0.05). ROC curve analysis results showed that the area under curve of Tp-Te/QT ratio of predicting malignant arrhythmia after thrombolytic  was higher than that of Tp-Tec and QTc (0.884 vs 0.605, 0.773). The cutoff value of Tp-Tec, QTc and Tp-Te/QT ratio were 124.22 ms,  440.60 ms and 0.29, respectively. The predicted sensitivity of the Tp-Te/QT ratio was 80.00%, and the specificity was 89.04%. Conclusions  The Tp-Tec, QTc and Tp-Te/QT ratio are helpful to early predict the occurrence of malignant arrhythmias in patients with acute STEMI after thrombolysis, and the ratio of Tp-Te/QT is the most valuable in predicting malignant arrhythmias. All of them are related to poor prognosis, which is helpful for clinicians to evaluate the prognosis of patients early and take targeted measures.