摘要
目的 探究心电图QRS波群振幅(QRSWA)联合血清尿酸(SUA)水平评估慢性心力衰竭(CHF)患者预后的价值。方法 选取2022年3月至2023年9月于榆林市第一医院收治的126例CHF患者为研究对象,根据患者有无主要不良心脏事件(MACE)将其分为MACE组(n=41)和非MACE组(n=85)。比较两组患者基线资料[纽约心脏协会(NYHA)分级、左室射血分数(LVEF)等]、生化指标[总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、SUA、白细胞(WBC)、血浆N-末端前体脑钠肽(NT-proBNP)]、心电图QRS特征[QRS波群振幅(QRSWA)、QRS波群时限],并分析心电图QRS特征、SUA与临床指标的相关性。采用二元Logistic回归分析影响CHF发生MACE的危险因素;绘制ROC工作特征曲线分析心电图QRSWA联合SUA对CHF患者预后的诊断价值。结果 两组NYHA分级、LVEF、NT-proBNP、SUA比较,差异有统计学意义(P<0.05)。MACE组QRSWA低于非MACE组(P<0.05),QRS波时限高于非MACE组(P<0.05)。Pearson或Spearman相关性分析显示,QRS波时限、SUA与NYHA分级、NT-proBNP呈正相关(P<0.05),与LVEF呈负相关(P<0.05);QRSWA与NYHA分级、NT-proBNP呈负相关(P<0.05),与LVEF呈正相关(P<0.05)。Logistic回归分析显示,NYHA分级(OR=2.625,95%CI:1.812~3.802)、LVEF(OR=1.578,95%CI:1.267~1.965)、NT-proBNP(OR=3.248,95%CI:1.735~6.081)、SUA(OR=1.137,95%CI:1.041~1.241)、QRSWA(OR=1.260,95%CI:1.067~1.488)、QRS波时限(OR=3.397,95%CI:2.804~4.117)与CHF患者预后相关。ROC曲线显示,QRSWA、QRS波时限、SUA及三者联合检测ROC曲线下面积分别为0.688、0.827、0.828、0.931,联合检测敏感度均高于单项指标检测。结论 QRSWA、QRS波时限、SUA均与CHF患者预后相关,可作为临床参考指标。
Objective To explore the value of electrocardiogram QRS wave amplitude(QRSWA)combined with serum uric acid(SUA)level in evaluating the prognosis of patients with chronic heart failure(CHF).Methods Totally 126 patients with CHF in the First Hospital of Yulin from March 2022 to September 2023 were selected as the study subjects.According to the occurrence or absence of major adverse cardiac events(MACE),they were divided into MACE group(n=41)and non-MACE group(n=85).Baseline data[New York Heart Association(NYHA)classification,left ventricular ejection fraction(LVEF)],biochemical indicators[total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),SUA,white blood cell(WBC),plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)]and electrocardiogram QRS characteristics(QRSWA,QRS wave duration)were compared between the two groups.The correlation between electrocardiogram QRS characteristics,SUA and clinical indicators was analyzed.Binary logistic regression analysis was used to analyze the risk factors affecting the occurrence of MACE in CHF patients.Receiver operator characteristic(ROC)working curve was plotted to analyze the diagnostic value of electrocardiogram QRSWA combined with SUA for the prognosis of patients with CHF.Results There were significant differences in NYHA classification,LVEF,NT-proBNP and SUA between the two groups(P<0.05).Compared with the non-MACE group,the MACE group exhibited lower QRSWA but longer QRS wave duration(P<0.05).Pearson or Spearman correlation analysis suggested that QRS wave duration and SUA were positively correlated with NYHA classification and NT-proBNP(P<0.05),but negatively correlated with LVEF(P<0.05).QRSWA was negatively correlated with NYHA classification and NT-proBNP(P<0.05),but positively correlated with LVEF(P<0.05).Logistic regression analysis revealed that NYHA classification(OR=2.625,95%CI:1.812-3.802),LVEF(OR=1.578,95%CI:1.267-1.965),NT-proBNP(OR=3.248,95%CI:1.735-6.081),SUA(OR=1.137,95%CI:1.041-1.241),QRSWA(OR=1.260,95%CI:1.067-1.488)and QRS wave duration(OR=3.397,95%CI:2.804-4.117)were associated with the prognosis of CHF patients.ROC curve showed that the areas under the ROC curves(AUCs)of QRSWA,QRS wave duration,SUA and their combined detection were 0.688,0.827,0.828 and 0.931,respectively.The sensitivity of their combined detection was higher than that of single indicator detection(P<0.05).Conclusion QRSWA,QRS wave duration and SUA are all related to the prognosis of CHF patients,which can be used as clinical reference indicators.
作者
刘娜娜
刘通
刘雅
任梅梅
Liu Nana;Liu Tong;Liu Ya;Ren Meimei(Department of General Medicine,The First Hospital of Yulin,Yulin 719000,China;Department of Cardiology,The First Hospital of Yulin,Yulin 719000,China;Department of Electrocardiography,The First Hospital of Yulin,Yulin 719000,China)
出处
《成都医学院学报》
2025年第2期278-282,共5页
Journal of Chengdu Medical College
基金
陕西省科学技术厅科技发展计划项目(No:20190510163)。
关键词
心力衰竭
心电图
QRS波群振幅
血清尿酸
预后
Heart failure
Electrocardiogram
QRS wave amplitude
Serum uric acid
Prognosis
