【摘要】 目的：探究急性心肌梗死（AMI）患者T波顶点至T波终末段（Tp-Te）心电图特征、血清可溶性CD40配体（CD40L）、肿瘤坏死因子（TNF-a）与室性心律失常的关系。方法：选取2018年3月至2019年3月本院收治的128例AMI患者，根据患者处在急性期时是否发生过室性心动过速（VT）或心室颤动（VF），分别为室性心律失常观察组（64例）、无室性心律失常对照组（64例），以及同期参与体检的55例健康人群作为此次研究的健康对照组。观察分析三组Tp-Te心电图相关指标、CD40L、TNF-a与室性心律失常发生的关系。结果：急性期发生过VT或VF所导致的室性心律失常观察组的Tp-Te相较与无室性心律失常组对照组明显偏高（P<0.05）；观察组患者的血清CD40L、TNF-a水平均要比对照组高（P<0.05）；健康对照组的Tp-Te、CD40L及TNF-a水平均比观察组及对照组低（F=176.258、186.635、333.816 ，P<0.05）；ROC曲线显示，Tp-Te、CD40L及TNF-a水平诊断AMI患者室性心律失常的AUC为0.979、0.866、0.927，诊断灵敏度、特异度：Tp-Te为100%、95.3%，CD40L为70.9%、78.1%，TNF-a为100%、87.5%。结论：急性心肌梗死患者Tp-Te心电图特征、CD40L、TNF-a对室性心律失常有一定诊断价值，可以将其作为临床检测的重要指标。

【Abstract】 Objective:To investigate the relationship between T-wave apex to T-wave terminal segment(TpTe)electrocardiogram in patients with acute myocardial infarction(AMI), serum soluble CD40 ligand(CD40L), tumor necrosis factor(TNFa)and ventricular arrhythmia. Methods:From March 2018 to March 2019, 128 patients with AMI were selected. According to whether ventricular tachycardia (VT) or ventricular fibrillation (VF) occurred in acute phase, there were 64 patients in the observation group, 64 patients in the control group and 55 healthy people who participated in the physical examination at the same time as the healthy control group. The relationship between electrocardiogram (ECG) and CD40L,TNF-a and ventricular arrhythmia in three groups of Tp-Te was observed and analyzed.Results:The levels of serum CD40L and TNF-a in the observation group were higher than that of the control group (P <0.05), and the levels of the serum CD40L and TNF-a in the group were higher than that of the control group (P <0.05), and Tp-Te in the healthy control group was higher than that of the control group (P <0.05). The levels of CD40L and TNF-a were lower than those in the control group (F = 176.258, 186.635, 333.816, P <0.05); the ROC curve showed that the patients with AMI at the level of Tp-Te, CD40L and TNF-a The AUC of ventricular arrhythmia was 0.979, 0.866, 0.927, diagnostic sensitivity, specificity: Tp-Te was 100%, 95.3%, CD40L was 70.9%, 78.1%, and TNF-a was 100%, 87.5%.Conclusion:The characteristics of Tp-Te electrocardiogram (ECG) and CD40L,TNF-a in patients with acute myocardial infarction (AMI) are valuable in the diagnosis of ventricular tachyarrhythmia, which can be used as an important index for clinical detection.