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目的:评价T波峰点到末端的间期(Tpeak-Tend interval,Tp-e间期)和其他心电图参数对变异型心绞痛(VA)患者恶性室性心律失常(MVAE)发生的预测作用。方法:60例单纯VA患者(无MVAE组)和18例VA合并MVAE的患者(MVAE组)入选本研究。使用t检验、Logistic回归分析和受试者工作曲线(ROC)分析ST段抬高时期心电图参数和MVAE(室性心动过速/心室颤动、晕厥和成功复苏的心源性猝死)发生的关系。结果:MVAE组比无MVAE组有更长的校正QT间期离散度[cQTd:(49.55±15.4)ms∶(39.98±7.4)ms;P=0.017]、校正的Tp-e间期[cTp-e:(162.07±24.8)ms∶(127.69±12.9)ms;P<0.001]和校正的Tp-e间期离散度[cTp-ed:(55.55±15.4)ms∶(39.98±7.4)ms;P<0.001],并且有更大的Tp-e/QT比值(0.355±0.05∶0.297±0.03;P<0.001)。血管痉挛缓解并且抬高的ST段和倒置的T波恢复至正常水平后,两组间QTc间期、cQTd、cTp-e间期、cTp-ed和Tp-e/QT比值均没有明显差异。单因素回归分析显示,cQTd(OR=1.117,95%CI:1.013~1.230,P=0.026)、cTp-e间期(OR=1.149,95%CI:1.057~1.248,P=0.001)、Tp-e/QT比值(OR=1.361,95%CI:1.136~1.630,P=0.002)和cTp-ed(OR=1.452,95%CI:1.150~1.832,P=0.001)均与MVAE的发生有关。多因素逐步回归分析显示,只有cTp-ed可以进入回归方程作为预测因子。ROC曲线下面积(AUC)cQTd为0.724,cTp-e间期为0.841,Tp-e/QT比值为0.924,cTp-ed为0.933(均P<0.05)。Z检验显示,cTp-ed(0.933)的AUC与cQTd(0.724)、cTp-e间期(0.841)、Tp-e/QT比值(0.924)的AUC相比均有显著差异(均P<0.05),Tp-e/QT比值的AUC与cQTd相比有显著差异(均P<0.05)。结论:cQTd、cTp-e间期、Tp-e/QT比值和cTp-ed在合并MVAE的VA患者中明显增高,均可预测MVAE的发生,其中cTp-ed是最敏感的独立预测因子。
OBJECTIVE: To evaluate the predictive value of T-peak to T-interval and other electrocardiographic parameters in predicting the occurrence of malignant ventricular arrhythmia (MVAE) in patients with variant angina (VA). Methods: Sixty patients with simple VA (without MVAE) and 18 with VA combined with MVAE (MVAE) were enrolled in this study. Logistic regression analysis and receiver operating characteristic curve (ROC) were used to analyze the relationship between electrocardiogram parameters of ST segment elevation and occurrence of MVAE (ventricular tachycardia / ventricular fibrillation, syncope and successful sudden cardiac death) using t test, logistic regression analysis and receiver operating characteristic curve. Results: The MVTE group had a longer corrected QT interval dispersion than the non-MVAE group [cQTd: (49.55 ± 15.4) ms: (39.98 ± 7.4) ms; P = 0.017] e: (162.07 ± 24.8) ms: (127.69 ± 12.9) ms; P <0.001] and corrected Tp-e interphase divergence [cTp-ed: (55.55 ± 15.4) ms: (39.98 ± 7.4) ms; P <0.001] and had a larger Tp-e / QT ratio (0.355 ± 0.05: 0.297 ± 0.03; P <0.001). There was no significant difference in the QTc interval, cQTd, cTp-e interval, cTp-ed and Tp-e / QT ratios between the two groups after the vasospasm was relieved and the elevated ST segment and inverted T wave returned to normal levels. Univariate regression analysis showed that there was no significant difference between the cTp-e interval (OR = 1.149, 95% CI: 1.057-1.248, P = 0.001) E / QT ratio (OR = 1.361, 95% CI: 1.136-1.630, P = 0.002) and cTp-ed (OR = 1.452, 95% CI: 1.150-1.832, P = 0.001) were all associated with the occurrence of MVAE. Multi-factor stepwise regression analysis showed that only cTp-ed could enter the regression equation as a predictor. The area under the ROC curve (AUC) was 0.724, the cTp-e interval was 0.841, the Tp-e / QT ratio was 0.924, and the cTp-ed was 0.933 (all P <0.05). Z test showed that the AUC of cTp-ed (0.933) was significantly different from that of cQTd (0.724), cTp-e interval (0.841) and Tp-e / QT ratio (0.924) , AUC of Tp-e / QT ratio were significantly different from cQTd (all P <0.05). CONCLUSION: The cQTd, cTp-e interval, Tp-e / QT ratio and cTp-ed were significantly increased in VA patients with MVAE. All of them can predict the occurrence of MVAE. Among them, cTp-ed is the most sensitive independent predictor.