综合心电图计分法在诊断冠心病多支病变中的应用  

Evaluation of Integrated ECG Scoring Method On Mutiple-Vessels Coronary Heart Disease

作　　者：贾如意[1] 薛建峰[1] 姜婕[1] 王涛[1] 虞化鹏[1] 柳翠霞[1] 殷洁[1] 

机构地区：[1]济南市第四人民医院心内科济南市心血管病研究所,山东省济南市250031

出　　处：《中国动脉硬化杂志》2007年第2期133-136,共4页Chinese Journal of Arteriosclerosis

摘　　要：目的探讨静息状态下冠心病患者(非急性心肌梗死、无胸痛发作状态)常规十二导联心电图对冠状动脉多支病变的预测作用。根据冠心病患者静息状态下的十二导联心电图,制定一套简单易行的对冠状动脉多支病变有一定诊断价值的、新的心电图计分系统。方法分析拟诊为不稳定型心绞痛行冠状动脉造影患者(104例)的造影资料及冠状动脉造影前心电图资料。选择性多体位左、右冠状动脉造影,以左主干、前降支、回旋支和右冠状动脉中任一支狭窄≥50%者为阳性,将患者分为阴性组(8例)、多支病变组(30例)和非多支病变组(66例)。计数各组心电图aVR导联ST段抬高病例数、异常导联数、ST段移位绝对值之和、异常导联数+ST段移位绝对值之和及ST段时间,进行统计学分析。选取年龄及以上5项心电图指标,每项指标达到规定记1分,达标项数之和为该患者的心电图积分(自称为综合心电图计分法)。分别计数各组综合心电图计分法积分,并与冠状动脉病变支数进行相关性分析。结果以上5项心电图指标多支病变组与非多支病变组比较差异有显著性。综合心电图计分法积分均值阴性组、非多支病变组和多支病变组分别为0.50±0.53、2.20±1.76和4.20±1.21,三组间差异有显著性(P<0.01)。综合心电图计分法积分与冠状动脉狭窄支数呈正相关(r=0.491,P=0.000)。综合心电图计分法的敏感性为83%,特异性为77%,阳性预测值为60%,阴性预测值为92%。结论综合心电图计分法优于传统的单项心电图评价指标,该法简单易行,对诊断冠心病患者多支病变有较好的敏感性和特异性。综合心电图计分法对非急性心肌梗死、胸痛发作难以及时行心电图检查的冠心病患者多支病变的诊断有重要价值。Aim To Find the relationship between the 12-lead resting electrocardiograph （ECG） features and multiple-vessel coronary artery disease, and evaluate the value of 12-lead resting ECG on predicting multiple-vessel coronary heart disease, EGG and coronary angiography （GAG） of 104 patients were analyzed. All patients were divided into negative group （8 patients）, multiple-vessel disease group （30 patients）, non-multiple-vessel disease group （66 patients）. ST-segraent elevation in lead aVR, the number of leads with abnormal ST segment, the sum of absolute ST-segment deviation value, the sum of absolute ST-segment deviation value plus the number of leads with abnormal ST segment, and ST segment time were analyzed among the three groups. The indexes combining with the results of CAG were analyzed. The ECG score method consisted of age and the ECG indexes. Each index reached the provisions as 1 score. We defined the sum of each index as the patient＇s integrated ECG aggregate score and 4 score was the diagnostic cutpoint. Results There were significant difference between non-multiple-vessel disease group and multiple-vessel disease group for the ECG indexes and age. There are significant differences among the three groups for the integrated ECG aggregate score （ P 〈 0.01 ）. Integrated ECG aggregate score was positively related to the number of narrowed coronary arteries（r=0.491, P=0.000）. The sensitivity and specificity of the integmted ECG score method were 83 %, 77 % respectively. Conclusion The integrated ECG score method plays an important role in distinguishing multiple-vessel disease of eoronary heart disease.

关 键 词：冠心病 冠状动脉造影 多支病变 综合心电图计分法 

分 类 号：R541.4[医药卫生—心血管疾病]