急性ST段抬高型心肌梗死不同心电图表现患者心肌损伤标志物及无复流风险观察

doi:10.3969/j.issn.1671-7171.2023.12.026

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摘要【目的】探讨急性ST段抬高型心肌梗死患者心电图缺血分级与心肌损伤标志物、无复流之间的相关性。【方法】回顾性分析2019年1月至2022年1月本院收治的80例急性ST段抬高型心肌梗死患者的临床资料,根据心电图缺血分级分为Ⅱ级缺血组(n=32)和Ⅲ级缺血组(n=48)。比较两组心肌损伤标志物[高敏肌钙蛋白(hs-cTnI)、N末端B型利钠肽原(NT-proBNP)、肌酸激酶同工酶(CK-MB)]水平,采用受试者工作特征(ROC)曲线分析心肌损伤标志物指标预测急性ST段抬高型心肌梗死Ⅲ级缺血的价值,采用Logistic多因素逐步回归分析急性ST段抬高型心肌梗死患者心电图缺血分级Ⅲ级的影响因素。【结果】Ⅱ级缺血组患者无复流占比低于Ⅲ级缺血组,hs-cTnI、NT-proBNP水平低于Ⅲ级缺血组,CK-MB水平高于Ⅲ级缺血组(P<0.05)。ROC曲线分析显示,hs-cTnI、NT-proBNP、CK-MB水平均可用于急性ST段抬高型心肌梗死Ⅲ级缺血的预测,曲线下面积分别为0.861、0.706、0.792(P<0.05)。多因素Logistic回归分析显示,无复流、hs-cTnI≥1.545 ng/mL、NT-proBNP≥1075.005 ng/mL、CK-MB＜38.253 ng/mL是急性ST段抬高型心肌梗死心电图缺血分级Ⅲ级的危险因素(P<0.05)。【结论】不同心电图缺血分级急性ST段抬高型心肌梗死患者心肌损伤标志物水平及复流情况存在差异,且心肌损伤标志物和无复流可用于急性ST段抬高型心肌梗死心电图缺血分级的预测。

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	峁存

关键词 ： ST段抬高型心肌梗死, 急性病, 心电描记术, 肌钙蛋白/血液, 利钠肽,脑/血液, 肌酸激酶,MB型/血液

Abstract：【Objective】 To explore the correlation between electrocardiogram ischemic grading, myocardial injury markers, and no reflow in patients with acute ST segment elevation myocardial infarction. 【Methods】A retrospective analysis was conducted on the clinical data of 80 patients with acute ST segment elevation myocardial infarction admitted to our hospital from January 2019 to January 2022. According to the electrocardiogram ischemic grading, they were divided into grade Ⅱ ischemic group (n=32) and grade Ⅲ ischemic group (n=48). We compared the levels of two groups of myocardial injury biomarkers [high-sensitivity troponin (hs-cTnI), N-terminal B-type brain natriuretic peptide(NT-proBNP), and creatine kinase isoenzyme (CK-MB)], and used receiver operating characteristic (ROC) curves to analyze the value of myocardial injury biomarker indicators in predicting grade Ⅲ ischemia in acute ST segment elevation myocardial infarction. Logistic multiple factor stepwise regression was used to analyze the influencing factors of electrocardiogram ischemia grade Ⅲ in patients with acute ST segment elevation myocardial infarction. 【Results】The proportion of patients in the grade Ⅱ ischemic group without reflow was lower than that in the grade Ⅲ ischemic group, and the levels of hs-cTnI and NT-proBNP were lower than those in the grade Ⅲ ischemic group. The levels of CK-MB were higher than those in the grade Ⅲ ischemic group (P<0.05). ROC curve analysis showed that hs-cTnI, NT-proBNP, and CK-MB levels can all be used for predicting grade Ⅲ ischemia in acute ST segment elevation myocardial infarction, with areas under the curves of 0.861, 0.706, and 0.792 (P<0.05), respectively. Multivariate logistic regression analysis showed that no reflow, hs-cTnI ≥ 1.545 ng/mL, NT-proBNP ≥ 1075.005 ng/mL, and CK-MB<38.253 ng/mL were risk factors for ischemic grade Ⅲ on electrocardiogram in acute ST segment elevation myocardial infarction (P<0.05). 【Conclusion】There are differences in the levels of myocardial injury markers and reflow in patients with acute ST segment elevation myocardial infarction with different electrocardiographic ischemic grades, and myocardial injury markers and no reflow can be used to predict the ischemic grade of acute ST segment elevation myocardial infarction electrocardiograms.

Key words： ST Elevation Myocardial Infarction Acute Disease Electrocardiography Troponin/BL Natriuretic Peptide, Brain/BL Creatine Kinase, MB Form/BL

收稿日期: 2022-11-10

中图分类号:

R542.22

引用本文:

峁存. 急性ST段抬高型心肌梗死不同心电图表现患者心肌损伤标志物及无复流风险观察[J]. 医学临床研究, 2023, 40(12): 1912-1915.
MAO Cun. Observation of Myocardial Injury Markers and No Risk of Reflow in Patients with Acute ST Segment Elevation Myocardial Infarction with Different Electrocardiogram Manifestations. JOURNAL OF CLINICAL RESEARCH, 2023, 40(12): 1912-1915.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.12.026 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I12/1912

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