广州医科大学学报

目的：探讨心电图Tp-Te/QT比值（Tp-Te间期与QT间期的比值）和肌酸激酶同工酶（CK-MB）对急性心肌梗死（AMI）患者并发室性心律失常（VA）及预后的评估价值。方法：选取2021年12月1日至2023年10月在本院收治的AMI患者122例，根据患者是否并发VA分为并发组69例和非并发组53例。记录所有患者的一般资料；患者入院后24 h后检测血清CK-MB水平，记录所有患者的心电图，测量Tp-Te间期、QT间期和Tp-Te/QT比值。多因素logistic回归分析评估Tp-Te/QT和CK-MB与并发VA和AMI患者预后的影响因素。采用受试者工作特征曲线（ROC曲线）分析Tp-Te/QT和CK-MB对AMI患者并发VA及预后的预测价值。结果：并发组患者Tp-Te/QT、CK-MB高于非并发组（P<0.05）。多因素logistic回归分析结果显示Tp-Te/QT、CK-MB是AMI患者并发VA的危险因素（P<0.05）。ROC结果显示，Tp-Te/QT、CK-MB及联合预测对AMI患者并发VA的曲线下面积（AUC）为0.849、0.851、0.930;AUC比较结果显示，联合预测优于单独预测（Z=2.803、3.062,P<0.05）。预后不良组患者高血压、糖尿病占比高于预后良好组（P<0.05）。预后不良组患者Tp-Te/QT、CK-MB高于预后良好组（P<0.05）。多因素logistic回归分析Tp-Te/QT、CK-MB是AMI患者预后不良的危险因素（P<0.05）。ROC结果显示，Tp-Te/QT、CKMB及联合预测对AMI患者并发VA的AUC为0.840、0.844、0.947;AUC比较结果显示，联合预测优于单独预测（Z=2.618、2.394,P<0.05）。结论：心电图Tp-Te/QT联合CK-MB对AMI并发VA及预后的评估价值较高。

Objective:To explore the effect of electrocardiogram Tp-Te/QT ratio(ratio of Tp-Te interval to QT interval)and creatine kinase isoenzyme(CK-MB)in patients with acute myocardial infarction(AMI)complicated by ventricular rhythm. Abnormality(VA)and prognostic evaluation value.Methods:122 AMI patients admitted to our hospital from December 1,2021 to October 2023 were selected and divided into a concurrent group of 69 patients and a non-complicated group of 53 patients according to whether they were complicated by VA. The general information of all patients was recorded;serum CK-MB levels were measured 24 hours after admission,electrocardiograms of all patients were recorded,and Tp-Te interval,QT interval and Tp-Te/QT ratio were measured. Multivariate logistic regression analysis evaluated the influencing factors of Tp-Te/QT and CK-MB on the prognosis of patients with concurrent VA and AMI. The receiver operating characteristic curve(ROC curve)was used to analyze the predictive value of Tp-Te/QT and CK-MB for VA and prognosis in patients with AMI.Results:Tp-Te/QT and CK-MB in the concurrent group were higher than those in the non-complicated group(P<0.05). Multivariate logistic regression analysis results showed that Tp-Te/QT and CK-MB were risk factors for VA in patients with AMI(P<0.05). The ROC results showed that the area under the curve(AUC)of Tp-Te/QT,CK-MB and combined prediction for VA in AMI patients were 0.849,0.851,and 0.930;the AUC comparison results showed that the combined prediction was better than the single prediction(Z=2.803,3.062,P<0.05). The proportions of hypertension and diabetes in the poor prognosis group were higher than those in the good prognosis group(P<0.05). The Tp-Te/QT and CK-MB of patients in the poor prognosis group were higher than those in the good prognosis group(P<0.05). Multivariate logistic regression analysis showed that Tp-Te/QT and CK-MB were risk factors for poor prognosis in patients with AMI(P<0.05). The ROC results showed that the AUCs of Tp-Te/QT,CKMB and combined prediction for VA in AMI patients were 0.840,0.844,and 0.947;the AUC comparison results showed that the combined prediction was better than individual prediction(Z=2.618,2.394,P<0.05).Conclusion:ECG Tp-Te/QT combined with CK-MB has a high value in evaluating AMI complicated by VA and prognosis.