ST/HR斜率和ST/HR滞后诊断冠心病的价值  

Values of ST/HR slope and ST/HR hysteresis in diagnosing coronary artery disease

作　　者：张正洪[1] 李永安[2] 吕波[2] 

机构地区：[1]重庆市第二人民医院心内科,402160 [2]重庆医科大学附属第一医院心内科,400016

出　　处：《重庆医学》2008年第20期2305-2307,共3页Chongqing medicine

摘　　要：目的分析ST/HR斜率和ST/HR滞后对冠心病诊断的价值。方法应用ST/HR斜率和ST/HR滞后自动分析系统,以冠状动脉造影为标准,确定38例患者为病例组,探讨ST/HR斜率和ST/HR滞后诊断冠心病的敏感性;以50例健康人为健康人群组,探讨两指标诊断冠心病的特异性。结果(1)ST/HR斜率与ST段标准的普通运动心电图试验诊断冠心病的敏感性分别为92.1%(35/38)和73.7%(28/38)(P=0.033),特异性分别为94.0%(47/50)和78.0%(39/50)(P=0.021);(2)斜率值大于或等于6.0μV.bp-1.min-1时,ST/HR斜率诊断三支冠状动脉病变的敏感性为91.7%(11/12),特异性为61.5%(16/26);(3)ST/HR滞后诊断冠心病的敏感性为94.7%(36/38),明显高于普通运动心电图试验ST段标准的73.7%(28/38)(P=0.012),但特异性仅为54.0%(27/50),明显低于普通运动心电图试验ST段标准的78.0%(39/50)(P=0.011),两者的准确性分别为71.6%(63/88)和76.1%(67/88)(P=0.493)。结论ST/HR斜率对冠心病的诊断有重要价值,其敏感性、特异性均高于ST段标准的普通运动心电图试验,且可作为评价是否存在三支冠状动脉病变的参考。而ST/HR滞后在冠心病的诊断方面并未显示出优于普通运动心电图试验,其临床推广应用价值有限。Objective To assess the diagnostic values of the ST segment/heart rate（ST/HR） slope and the ST segment/heart rate（ST/HR） hysteresis in diagnosing coronary artery disease （CAD）. Methods To explore the sensitivity and the specificity of ST/HR slope and ST/HR hysteresis in detecting CAD, Thirty-eight CAD patients confirmed by coronary angiography and 50 healthy volunteers were examined by computer assisted ST/HR slope and ST/HR hysteresis analysis. Results The sensitivity of ST/HR slope and standard exercise test electrocardiography （ECG） criteria in detecting CAD was 92. 1 % （35/38） versus 73.7 （28/38） （P=0. 033）. The specificity,94.0%（47/50） versus 78. 0% （39/50） （P 0.021）. A ST/HR slope ≥6.0μV· bp^-1 1 ·min ^-1 identified three-vessel CAD with a sensitivity of 91.7 % （11/12）, a specificity of 61.5 % （16/26）. The sensitivity of ST/HR hysteresis was significantly higher than that of standard exercise test ECG criteria in detecting CAD （94.7% vs 73.7% ,ie 36/38 vs 28/38,P= 0.0.12）,But the specificity of ST/HR hysteresis was significantly lower than that of standard exercise test ECG criteria in detecting CAD （54.0% vs 78.0%,ie 27/50 vs 39/50,P=0. 011）. The accuracy of ST/HR hysteresis and standard exercise test ECG criteria in detecting CAD was 71.6%（63/88） versus 76. 1% （67/88） （P=0. 493）. Conclusion These findings suggest that ST/HR slope is a good method for the diagnosis of CAD. The sensitivity and the specificity of ST/HR slope are significantly higher than that of standard exercise test ECG in detecting CAD. ST/HR slope can serve as reference at detecting three-vessel CAD. ST/ HR hysteresis is not markedly better than standard exercise test ECG criteria at detecting CAD and adds limited diagnostic value to CAD.

关 键 词：冠状动脉疾病 心率 ST/HR斜率 ST/HR滞后 

分 类 号：R541.4[医药卫生—心血管疾病] R540.4[医药卫生—内科学]