张哲 陶贵周

【摘要】 目的：探討ST段抬高型心肌梗死（STEMI）患者发生恶性室性心律失常（MVA）的相关因素。方法：选取2018年6月-2020年6月于本院心血管内科住院治疗的887例STEMI患者的临床资料进行回顾性分析。依据在院期间是否发生MVA将其分成发生MVA组（n=86）及未发生MVA组（n=801）。比较两组一般资料、生化指标、心电图指标及冠状动脉造影指标，并分析STEMI患者发生MVA的影响因素。结果：两组糖尿病病史、Killip分级≥Ⅲ级、白细胞、中性粒细胞、中性粒细胞百分比、中性粒细胞/淋巴细胞比值、超敏肌钙蛋白I、尿酸、肌酐、低密度脂蛋白胆固醇、总胆红素、血钾、J波方面比较，差异均有统计学意义（P<0.05）;将上述指标代入多因素logistic回归分析中显示Killip分级≥Ⅲ级、白细胞、中性粒细胞/淋巴细胞比值、超敏肌钙蛋白I、肌酐、血钾、总胆红素、J波是STEMI患者发生MVA的独立相关因素（P<0.05）。结论：Killip分级≥Ⅲ级、白细胞、中性粒细胞/淋巴细胞比值、超敏肌钙蛋白I、肌酐、血钾、总胆红素、J波是STEMI患者发生MVA的独立相关因素，对于存有以上相关因素的STEMI患者临床上应予以重视，并早期及时地采取干预措施，减少MVA的发生，改善患者预后。

【关键词】 ST段抬高型心肌梗死 恶性室性心律失常 J波

Analysis of Risk Factors for Malignant Ventricular Arrhythmias in Patients with ST-segment Elevation Myocardial Infarction/ZHANG Zhe， TAO Guizhou. //Medical Innovation of China， 2021， 18（16）： 00-006

[Abstract] Objective： To investigate the related factors of malignant ventricular arrhythmia （MVA） in patients with ST-segment elevation myocardial infarction （STEMI）. Method： The clinical data of 887 STEMI patients who were hospitalized in the department of cardiovascular medicine of our hospital from June 2018 to June 2020 were selected for retrospective analysis. According to whether MVA occurred during the hospitalization， they were divided into MVA group （n=86） and non-MVA group （n=801）. The general data， biochemical indexes， electrocardiogram indexes and coronary angiography indexes were compared between the two groups， and the influencing factors of MVA in STEMI patients were analyzed. Result： There were significant differences in diabetes history， Killip grade ≥Ⅲ， white blood cells， neutrophils， percentage of neutrophils， neutrophils/lymphocyte ratio， high-sensitivity cardiac troponin I， uric acid， creatinine， low density lipoprotein cholesterol， total bilirubin， serum potassium and J wave between the two groups （P<0.05）. Logistic regression analysis showed that Killip grade ≥Ⅲ， white blood cells， neutrophil/lymphocyte ratio， high-sensitivity cardiac troponin I， creatinine， serum potassium， total bilirubin and J wave were independent related factors for MVA in STEMI patients （P<0.05）. Conclusion： Killip grade ≥Ⅲ， white blood cells， neutrophils/lymphocyte ratio， high-sensitivity cardiac troponin I， creatinine， potassium， total bilirubin， J wave are independent related factors for MVA in STEMI patients. Clinical attention should be paid to STEMI patients with the above related factors， and early and timely intervention measures should be taken to reduce the occurrence of MVA and improve the prognosis of patients.

[Key words] ST-segment elevation myocardial infarction Malignant ventricular arrhythmia J wave

First-authors address： The First Affiliated Hospital of Jinzhou Medical University， Jinzhou 121000， China

doi：10.3969/j.issn.1674-4985.2021.16.001

ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）以其紧急的发病，快速的进展和较高的死亡率等特点现已成为冠心病中极其危重的类型。STEMI的发病率呈逐年递增趋势，同时患者年龄也愈发年轻化[1]。尽管再灌注治疗取得了重大的进展，但STEMI患者仍存在一定的死亡率，其中心源性猝死是STEMI患者的致命并发症，而恶性室性心律失常（malignant ventricular arrhythmia，MVA）主要包括持续性室性心动过速（ventricular tachycardia，VT）或心室颤动（ventricular fibrillation，VF），是心源性猝死发生的主要原因[2]。因此，及时识别高危患者，准确评估临床预后并预防MVA的发生已成为临床医生面临的新挑战。筛选敏感而特异的指标对于治疗和预防STEMI并发症具有重要价值。本研究通过回顾性分析887例STEMI患者的临床资料，探讨发生MVA的危险因素，为临床预防与治疗提供一定的帮助，现报道如下。

1 资料与方法

1.1 一般资料 选取2018年6月-2020年6月于本院心血管内科住院治疗的887例STEMI患者的临床资料进行回顾性分析。……