【摘要】 目的:探究心电图QRST夹角与QRS波群时限对老年急性冠脉综合征(acute coronary syndrome, ACS)患者主要不良心血管事件(major adverse cardiovascular events, MACE)的预测价值。方法:选择2020年5月—2023年5月我院收治的154例ACS患者为研究对象。根据患者随访期间有无发生MACE,将患者分为MACE组(47例)和非MACE组(107例)。比较2组患者临床资料、QRST夹角及QRS波群时限，多元线性回归分析QRST夹角、QRS波群时限与血管内皮功能指标的相关性，多因素Cox分析QRST夹角、QRS波群时限与MACE发生的关系，采用限制性立方样条模型分析QRST夹角、QRS波群时限与MACE的剂量反应关系，受试者工作特征曲线分析QRST夹角、QRS波群时限的灵敏度和特异度。Log-binomial回归分析计算QRST夹角、QRS波群时限与MACE亚型之间的粗风险比和调整混杂因素后的风险比。结果:MACE组患者年龄、QRST夹角、QRS波群时限、Gensini积分、血清肌酐、肌钙蛋白I、肌酸激酶同工酶、内皮素-1、血管性假血友病因子、水溶性凝聚素样氧化低密度脂蛋白受体-1水平显著高于非MACE组，收缩压、左心室射血分数、一氧化氮显著低于非MACE组，2组间差异有统计学意义(P<0.05)。多元线性回归分析结果显示，QRST夹角、QRS波群时限与内皮素-1、血管性假血友病因子、水溶性凝聚素样氧化低密度脂蛋白受体-1存在显著正相关关系(β>0,P<0.05),与一氧化氮存在显著负相关关系(β<0,P<0.05)。QRST夹角、QRS波群时限是患者发生MACE的独立危险因素，无论是男性还是女性，QRST夹角、QRS波群时限与MACE发生均存在非线性剂量-反应关系。QRST夹角>65°的患者与QRST夹角≤65°的患者在再发心绞痛和非计划再次血运重建方面差异有统计学意义(P<0.05),QRS波群时限>110 ms的患者与QRS波群时限≤110 ms的患者在恶性心律失常和非计划再次血运重建方面差异有统计学意义(P<0.05)。结论:MACE组患者QRST夹角、QRS波群时限大于非MACE组，QRST夹角、QRS波群时限是老年ACS患者发生MACE的独立危险因素，与MACE发生存在非线性剂量-反应关系。更多还原

【Abstract】 Objective: To investigate the predictive value of electrocardiogram QRST angle and QRS group duration on major adverse cardiovascular events(MACE) in elderly patients with acute coronary syndrome(ACS). Methods: A total of 154 patients with ACS admitted from May 2020 to May 2023 were selected as the study subjects. Patients were divided into MACE group(47 cases) and non-MACE group(107 cases) according to the occurrence of MACE during follow-up. Clinical data, QRST angle and QRS group duration were compared between two groups. The correlation between QRST angle, QRS group duration and vascular endothelial function indexes was analyzed by multiple linear regression. The relationship between QRST angle and QRS group duration and the occurrence of MACE was analyzed by multivariate Cox regression. The dose-response relationship between QRST angle, QRS duration and MACE subtype was analyzed by restricted cubic spline model. The sensitivity and specificity of QRST angle and QRS group duration were analyzed by receiver operating characteristic curves. The crude risk ratio and risk ratio after adjusting for confounding factors were calculated by log-binomial regression analysis. Results: The age, QRST angle, QRS group duration, Gensini score, serum creatinine, troponin I, creatine kinase isoenzyme, endothelin-1, von Willebrand factor, and human soluble lectin-like oxidized low density lipoprotein receptor-1 levels in the MACE group were significantly higher than those in the non-MACE group, while the systolic blood pressure, left ventricular ejection fraction, and nitric oxide were significantly lower than those in the non-MACE group, there were significant differences between the two groups(P<0.05). The results of multiple linear regression analysis showed that the QRST angle and the QRS group duration were positively correlated with endothelin-1, von Willebrand factor, and human soluble lectin-like oxidized low density lipoprotein receptor-1(β>0, P<0.05), and negatively correlated with nitric oxide(β<0, P<0.05). The QRST angle and QRS group duration were independent risk factors for MACE. There was a nonlinear dose-response relationship between the QRST angle and the QRS group duration and MACE in both male and female patients. There were significant differences between patients with QRST angle>65° and patients with QRST angle ≤65° in recurrent angina pectoris and unplanned revascularization(P<0.05). Patients with QRS group duration>110 ms and those with QRS group duration ≤110 ms had significant differences in malignant arrhythmia and unplanned revascularization(P<0.05). Conclusion: The QRST angle and QRS group duration of patients in the MACE group were higher than those in the non-MACE group. QRST angle and QRS group duration are independent risk factors for the occurrence of MACE in elderly patients with ACS, and have a non-linear dose-response relationship with the occurrence of MACE.更多还原