目的 探讨心电图胸导联∑Q/∑R与血清脂蛋白a[lipoprotein a,Lp(a)]、载脂蛋白B(apolipoprotein B,ApoB)/载脂蛋白 A-1(apolipoprotein A-1,ApoA-1)联合预测急性 ST 段抬高心肌梗死(acute ST segment elevation myocardial infarction,ASTEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后短期预后的价值.方法 选取148例接受PCI术的ASTEMI患者,均于入院时行心电图、血清Lp(a)、ApoB、ApoA-1检查.PCI术后随访30 d,根据是否发生主要心血管不良事件分为预后不良组与预后良好组.结果 预后不良组∑Q、∑Q/∑R大于预后良好组,∑R小于预后良好组,血清Lp(a)、ApoB、ApoB/ApoA-1高于预后良好组,ApoA-1低于预后良好组,且∑Q/∑R与Lp(a)、ApoB/ApoA-1呈正相关(P均＜0.05);Cox回归分析显示,将其他混杂因素校正前后,心电图胸导联∑Q/∑R、血清Lp(a)、ApoB/ApoA-1均是ASTEMI患者PCI术后预后不良的独立危险因素(P均＜0.05);∑Q/∑R、Lp(a)、ApoB/ApoA-1联合预测预后不良的曲线下面积为0.915(95％CI:0.857～0.974),大于三者单独预测.结论 心电图胸导联∑Q/∑R联合Lp(a)、ApoB/ApoA-1预测ASTEMI患者PCI术后短期预后的价值较高,可作为临床预测预后的潜在途径.
The Value of ECG Chest Leads ∑Q/∑R Combined with Lp(a)and ApoB/ApoA-1 in Predicting Short-term Prognosis after PCI in Patients with Acute ST Segment Elevation Myocardial Infarction
Objective To exploring the predictive value of chest leads of electrocardiogram(ECG)∑Q/∑R and serum lipoprotein a[Lp(a)],apolipoprotein B(ApoB)/apolipoprotein A-l(ApoA-1)for short-term prognosis after percutaneous coronary intervention(PCI)in patients with acute ST segment elevation myocardial infarction(ASTEMI).Methods Atotal of 148 patients with ASTEMI in our hospital who underwent PCI were selected,and all the patients underwent ECG and serum Lp(a),ApoB,ApoA-1 inspection.The patients were followed up for 30 days after PCI,and divided into a poor prognosis group and a good prognosis group based on whether major adverse cardiovascular events occurred.Results The poor prognosis group ∑Q,∑Q/∑R were greater than the good prognosis group,∑R was less than the good prognosis group;serum Lp(a),ApoB,ApoB/ApoA-1 were higher than the good prognosis group,and ApoA-1 was lower than the good prognosis group.And ∑Q/∑R were positively correlated with Lp(a)and ApoB/ApoA-1(P＜0.05);COX regression analysis,before and after correction for other confounding factors,ECG chest leads ∑Q/∑R,serum Lp(a),ApoB/ApoA-1 were independent risk factors for poor prognosis after PCI in patients with ASTEMI(P＜0.05).The combination of ∑Q/∑R,Lp(a),and ApoB/ApoA-1 predicts poor prognosis with an area under curve of 0.915(95％CI:0.857-0.974),which was greater than those predicted by the three alone.Conclusion It is suggested that the ECG chest lead ∑Q/∑R combined with Lp(a),ApoB/ApoA-1 has a high value in predicting the short-term prognosis of patients with ASTEMI after PCI,and it can be used as a potential way to predict the prognosis.
Acute ST-segment elevation myocardial infarctionECG chest leadsQ wave total amplitudeR wave total amplitudeLipoproteinApolipoproteinPercutaneous coronary intervention
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