12导联动态心电图联合尿酸水平对急性心肌梗死患者预后的预测价值
| 作者: |
1李志洪,
2刘敏
1 中国人民解放军陆军第七十三集团军医院心电图室，福建 厦门 361000 2 中国人民解放军陆军第七十三集团军医院心血管内科，福建 厦门 361000 |
| 通讯: |
刘敏
Email: chenhan1113@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2023.221315 |
摘要
目的：探究12导联动态心电图(ambulatory electrocardiogram，AECG)联合尿酸(uric acid，UA)水平对急性心肌梗死(acute myocardial infarction，AMI)患者预后的评估价值。方法：选取2020年1月至2022年1月中国人民解放军陆军第七十三集团军医院收治的107例AMI患者为研究对象，回顾性分析其临床资料(一般资料、AECG参数、UA水平)。使用单因素及logistic多因素回归模型分析AMI患者发生主要不良心脑血管事件(major adverse cardiac and cerebrovascular events，MACCE)的影响因素。根据患者随访期内是否发生MACCE，将其分为预后不良组(n=21)与预后良好组(n=86)。使用受试者操作特征(receiver operating characteristic，ROC)曲线分析AECG参数及UA水平对AMI患者预后的预测价值。结果：与预后良好组相比，预后不良组的震荡斜率(turbulence slope，TS)值、窦性R-R期间总体标准差(standard deviation of sinus R-R interval，SDNN)值明显更低，血清UA水平明显更高(均P<0.05)。Logistic回归分析结果显示：TS(OR=0.814)、SDNN(OR=0.829)、UA(OR=1.865)、肌钙蛋白I(cardiac troponin I，cTnI)水平(OR=1.425)均是MACCE发生的独立影响因素(均P<0.05)。Pearson相关性分析显示：TS与cTnI无明显相关性(r=-0.103，P=0.289)，SDNN与cTnI呈负相关(r=-0.314，P=0.001)，UA与cTnI呈正相关(r=0.324，P=0.001)。ROC曲线分析显示：TS、SDNN、UA预测AMI患者发生MACCE的曲线下面积(area under the curve，AUC)分别为0.779、0.691、0.682；且以TS、SDNN联合UA的AUC较高，分别为0.986、0.996。结论：12导联AECG参数联合UA对AMI患者预后具有较高的预测价值。
关键词：
12导联动态心电图；尿酸；急性心肌梗死；预后；预测
Prognostic value of 12-lead ambulatory electrocardiogram combined with uric acid level in patients with acute myocardial infarction
CorrespondingAuthor: LIU Min Email: chenhan1113@163.com
DOI: 10.3978/j.issn.2095-6959.2023.221315
Abstract
Objective: To explore the prognostic value of 12-lead ambulatory electrocardiogram (AECG) combined with uric acid (UA) in patients with acute myocardial infarction (AMI).
Methods: A total of 107 patients with AMI admitted to No. 73 Army Hospital of the People’s Liberation Army from January 2020 to January 2022 were selected as the research subjects, and their clinical data (general data, AECG parameters, and UA levels) were retrospectively analyzed. Univariate and logistic multivariate regression models were used to analyze the influencing factors of major adverse cardiac and cerebrovascular events (MACCE) in AMI patients. According to whether MACCE occurred during the follow-up period, patients were divided into a poor prognosis group (n=21) and a good prognosis group (n=86). The receiver operating characteristic (ROC) curve was used to analyze the prognostic value of AECG parameters and UA in patients with AMI.
Results: Compared with the good prognosis group, the turbulence slope (TS), standard deviation of sinus R-R interval (SDNN) in the poor prognosis group were significantly lower, and the serum UA level was significantly higher (all P<0.05). Logistic regression analysis showed that TS (OR=0.814), SDNN (OR=0.829), UA (OR=1.865), and cardiac troponin I (cTnI) (OR=1.425) were independent influencing factors of MACCE (all P<0.05). Pearson correlation analysis showed that TS was not significantly correlated with cTnI (r=-0.103, P=0.289), SDNN was negatively correlated with cTnI (r=-0.314, P=0.001), and UA was positively correlated with cTnI (r=0.324, P=0.001). ROC curve analysis showed that the area under the curve (AUC) of TS, SDNN, and UA in predicting MACCE in AMI patients was 0.779, 0.691, and 0.682, respectively. The AUC of TS and SDNN combined with UA was 0.986 and 0.996, respectively.
Conclusion: Twelve-lead AECG parameters combined with UA level has high prognostic value in prognosis of AMI patients.
Keywords：
12-lead ambulatory electrocardiogram; uric acid; acute myocardial infarction; prognosis; prediction
Methods: A total of 107 patients with AMI admitted to No. 73 Army Hospital of the People’s Liberation Army from January 2020 to January 2022 were selected as the research subjects, and their clinical data (general data, AECG parameters, and UA levels) were retrospectively analyzed. Univariate and logistic multivariate regression models were used to analyze the influencing factors of major adverse cardiac and cerebrovascular events (MACCE) in AMI patients. According to whether MACCE occurred during the follow-up period, patients were divided into a poor prognosis group (n=21) and a good prognosis group (n=86). The receiver operating characteristic (ROC) curve was used to analyze the prognostic value of AECG parameters and UA in patients with AMI.
Results: Compared with the good prognosis group, the turbulence slope (TS), standard deviation of sinus R-R interval (SDNN) in the poor prognosis group were significantly lower, and the serum UA level was significantly higher (all P<0.05). Logistic regression analysis showed that TS (OR=0.814), SDNN (OR=0.829), UA (OR=1.865), and cardiac troponin I (cTnI) (OR=1.425) were independent influencing factors of MACCE (all P<0.05). Pearson correlation analysis showed that TS was not significantly correlated with cTnI (r=-0.103, P=0.289), SDNN was negatively correlated with cTnI (r=-0.314, P=0.001), and UA was positively correlated with cTnI (r=0.324, P=0.001). ROC curve analysis showed that the area under the curve (AUC) of TS, SDNN, and UA in predicting MACCE in AMI patients was 0.779, 0.691, and 0.682, respectively. The AUC of TS and SDNN combined with UA was 0.986 and 0.996, respectively.
Conclusion: Twelve-lead AECG parameters combined with UA level has high prognostic value in prognosis of AMI patients.