云南不明原因猝死高危人群心电图分析  

Electrocardiogram analysis in high risk population of unexplained sudden death in Yunnan province

作　　者：冯莉[1] 任金马[1] 张健[2] 杨跃进[2] 黄文丽[3] 杨崇福 叶绍东[5] 李崇剑[5] 俞梦越[5] 任晓庆[1] 高鑫[5] 罗彤[5] 袁建松[5] 李北祥[5] 杨林[3] 龚菁[3] 腾思勇[6] 顾东风[5] 曾光[7] 浦介麟[1] 

机构地区：[1]中国医学科学院,北京协和医学院,心血管病研究所,阜外心血管病医院心律失常诊治中心,100037 [2]中国医学科学院,北京协和医学院,心血管病研究所,阜外心血管病医院,心力衰竭诊治中心,100037 [3]云南省地方病防治所 [4]云南省楚雄市克山病防治所 [5]中国医学科学院,北京协和医学院,心血管病研究所,阜外心血管病医院,心内科,100037 [6]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院病理与生理实验中心,100037 [7]中国医学科学院,北京协和医学院,心血管病研究所,阜外心血管病医院,群体遗传与防治研究室,100037

出　　处：《中华心血管病杂志》2007年第12期1155-1158,共4页Chinese Journal of Cardiology

基　　金：科技部国家重大科技攻关资助项目(2003BA712A11-01)

摘　　要：目的通过总结云南不明原因猝死高发地区人群的心电图特征,发现其规律并为进一步的病因学研究提供线索。方法自2005年9月至2006年7月间,对云南的不明原因猝死高发区(宁蒗、鹤庆、大姚)的三个自然村年龄为15～45岁的居民进行12导联静息心电图普查,以云南大理地区人群作为对照人群。共普查人群338例,男性175例,女性163例,平均年龄(33.4±11.7)岁。记录所有普查者的一般状况及疾病家族史。单盲法测量心电图各指标。结果猝死高发区与对照地区人群一样,常见心律失常发生率均低,仅见于个别居民。大姚地区左室高电压发生率(34.6%)显著高于其他地区(P 均<0.01)。上述三个猝死高发区人群的 QTc 较对照地区显著延长[分别为(428.92±25.71)ms、(440.67±28.03)ms、(417.70±24.00)ms 与(386.80±27.22)ms,P 均<0.05];U 波出现率仅鹤庆地区显著高于对照地区(P<0.05);QUc 上述各地区均显著高于对照地区[分别为(613.67±37.34)ms、(597.19±46.47)ms、(608.59±39.59)ms 与(589.33±41.27)ms,P 均<0.01];U 波呈宽大、高电压并与 T 波融合特征性表现;在7例有猝死家族史者中,6例有 U 波,4例呈猝死高发区特征性改变。结论云南省不明原因猝死高危人群心电图呈 QT 间期延长和 U 波特征性改变,提示可能存在潜在的心肌复极异常内因。Objective The purpose of this study was to analyze the electrocardiographic features of the people living in the area with high incidence of unexplained sudden deaths in Yunnan province. Method The electrocardiograms of 338 residents from three villages （Dayao, Ninglang, Heqing） with high incidence of unexplained sudden deaths and one control village （ Dali ） were analyzed [ averaged age was （ 33.4 ± 11.7） years, 175 men and 163 women]. Results The incidence of cardiac arrhythmias was similar low in all groups. The left ventricular hypertrophy was observed in 34. 6% of residents from Dayao. QTc significantly prolonged in the residents from all 3 high incidence areas compare the control area of Dali [ control （386.8 ±27.22） ms, Ninglang （428.92 ± 25.71 ） ms, Heqing （440. 67 ± 28.03 ） ms, Dayao （417.7 ± 24.00）ms, P 〈0.05 vs. control]. Incidence of U wave was significantly higher in Heqing village than that in control village（P 〈0.05）. The QUc of these 3 villages was： （613.67 ± 37.34） ms, （597.19 ±46.47） ms, （608.59 ± 39.59） ms respectively, and also significantly longer than the control village of Dali（589.33 ± 41.27）ms （P 〈 0.05 ） . The typical pattern of U wave presents as enlarged U wave and apparent T-U complex. In the 7 residents who have the family history of unexplained sudden death,6 residents have U wave, and 4 of them present typical U wave pattern. Conclusion The significant ECG changes in villages with high incidence of unexplained sudden death in Yunnan province were prolonged QTc, enlarged U wave and apparent T-U complex and these ECG features suggested the repolarization abnormalities of the heart in these subjects.

关 键 词：猝死 心脏 QT延长综合征 心电描记术 

分 类 号：R541[医药卫生—心血管疾病]