微伏级T波电交替对心性猝死高危人群的预测价值  

Prognostic value of microvolt level T.wave alternans in patients at high risk of sudden cardiac death

作　　者：杨萍[1] 郭涛[1] 汤亚明[1] 赵玲[1] 李淑敏[1] 刘中梅[1] 

机构地区：[1]昆明医学院第一附属医院心内科,650032

出　　处：《中华心血管病杂志》2008年第6期517-522,共6页Chinese Journal of Cardiology

摘　　要：目的探讨微伏级T波电交替（MTWA）对恶性室性心律失常（MVA）及心性猝死（SCD）的预测价值，探索时域法MTWA检测的正、异常值范围。方法连续选取2002年1月至2007年10月到昆明医学院第一附属医院就诊或健康体检者545例（男285例，女260例，平均年龄52岁），其中105例健康受检者设为对照组，既往有室性心动过速、心室颤动发作史或确诊为器质性心脏病且左室射血分数（LVEF）≤45％的138例设为SCD高危组。两组均成功检测MTWA、LVEF、心率变异性、非持续性室速、QRS、QTc等指标并完成随访，动态随访比较组间死亡及死因、MVA、再次住院、晕厥等事件的发生情况及其与MTWA等观测指标的相关性。结果时域法MTWA检测95％的正常参考值范围为MTWA〈37μV。平均（12．0±1．3）个月的随访期内，对照组无心血管事件发生；高危组死亡11例中SCD7例（MTWA阳性率分别为81．8％、85．7％），发生MVA的17例中MTWA阳性率88．2％，发生晕厥的9例中MTWA阳性率77．8％，随访期住院的21例中MTWA阳性率85．7％。多因素回归分析预测MVA的危险因素依次为MTWA阳性、LVEF≤35％、有心肺复苏史、有晕厥史。仅MTWA阳性与SCD显著相关。MTWA阳性、LVEF≤35％分别是预测MVA的独立指标（P〈0.01）。MTWA与LVEF≤35％联合预测MVA的敏感性91％、特异性66％、阳性预测价值27％、阴性预测价值98％，优于二者单独使用。41例埋藏式自动复律除颤器（ICD）患者，MTWA阳性率68，3％。随访中发生MVA并被ICD自动电除颤者的MTWA阳性率87，5％。结论（1）国人时域法MTWA正常参考值为〈37μV。（2）MTWA与LVEF一样对MVA有独立预测价值且其预测SCD的价值优于LVEF，二者联合可进一步提高预测价值。（3）MTWA阳性似可成为ICD置入的初筛指标之一。（4）时域法检测MTWA具有无创、简便、高效、易重复、经济等优点，有良好的推广Objective To explore the predict value of microvoh level T-wave alternans （MTWA） for malignant ventricular arrhythmia （MVA） and sudden cardiac death （SCD） in high risk patients. Methods A total of 105 healthy subjects （control group） and 138 patients with history of VT or VF or patients with LVEF≤45% （SCD high risk group） were included in this study （mean age 52 years old）. MTWA, LVEF, HRV, NSVT, QRS, QTc values and MACE data （death, causes of death, MVA, rehospitalization, syncope） during follow up （ 12.0 ± 1.3 ） months were obtained. Results The normal reference value of MTWA was defined as 〈 37 μV. Positive rate in SCD high risk group was significantly higher than that in control group （45.7% vs. 4.8% ,P 〈0.01 ）. There was no cardiovascular event report in control group. In SCD high risk group, there were 11 deaths （MTWA positive rate 81.8% ） including 7 SCD （ MTWA positive rate 85.7% ）, 17 MVA （ MTWA positive rate 88.2% ）, 9 cases of syncope （ MTWA positive rate 77.8% ） , 21 cases of re-hospitalization during the follow up （ MTWA positive rate 85.7% ）. Logistic regression analysis revealed that positive MTWA, a history of myocardial infarction and LVDd ≥ 60 mm were risk factors for all cause of death and positive MTWA was the only factor to predict SCD. The factors related to MVA in turn were positive MTWA, LVEF≤35%, a history of cardiopulmonary resuscitation and a history of syncope. Positive MTWA and LVEF≤35% are the independent risk factors for predicting MVA （P 〈0.01 ）. The sensitivity was 91% and specility was 66% by combined use of positive MTWA and LVEF≤35% to predict MVA. MTWA positive rates were 68.3% and 87.5% respectively in 41 ICD patients and ICD patients with automatic shock during follow up. Conclusion Non-invasive MTWA measurement could be used as a screening tool to predict SCD or MVA in high risk patients.

关 键 词：猝死 心脏 除颤器 植入型 心室颤动 心动过速 室性 

分 类 号：R686[医药卫生—骨科学]