平板运动试验中QRS时限延长对冠心病的诊断价值  

The diagnostic value of QRS duration extension on prediction of coronary artery disease during treadmill exercise testing

作　　者：刘红源[1] 

机构地区：[1]武汉科技大学附属天佑医院,430064

出　　处：《实用心电学杂志》2009年第2期93-95,共3页Journal of Practical Electrocardiology

摘　　要：目的探讨平板运动试验中QRS时限延长对冠心病的诊断价值。方法疑诊冠心病患者176例分别行冠状动脉造影术和活动平板运动试验,测定QRS时限和ST段下移值,分析上述指标对冠心病诊断的的敏感性、特异性和阳性预测值。结果冠心病组运动后QRS时限明显延长(87.13±7.47msvs76.52±7.63ms,P<0.01),而对照组运动前后QRS时限无显著性差异(72.51±6.83msvs75.66±7.42ms,P>0.05)。以运动中和运动后QRS延长>3ms、ST段呈水平型或下斜型压低≥1mm(J点后80ms)作为阳性评定标准,预测冠心病的敏感性为81.6%、77.2%,特异性84.5%、70.7%,阳性预测值91.2%、83.8%。两者联合应用的敏感性、特异性和阳性预测值分别是76.3%、87.9%和92.6%。结论QRS时限延长和ST段下移是可靠的诊断冠心病的运动心电图指标,两者联合应用可提高冠心病诊断的特异性和阳性预测值。Objective To explore the diagnostic value of QRS duration extension on prediction of coronary artery disease（CAD） during treadmill exercise testing（TET）. Methods 176 patients with suspicious CAD were tested by TET and coronary angiography（CAG） . QRS duration and depression of ST were measured. The sensitivity, specifity and positive predictive value of these parameters for CAD were analysied. Results QRS duration in CAD group after TET were obviously prolonged than that of before TET （ 87.13 ± 7.47ms vs 76.52 ± 7.63ms, P 〈 0.01 ）, it had no obvious changes in control group between after and before TET（72.51 ± 6.83ms vs 75.66 ± 7.42ms ,P 〉 0.05 ）. Positive parame- ters were defined as an extension of QRS duration 〉 3 ms and depression of ST ≥ 1 mm during and after TET. The sensitivity of these 2 parameters in the prediction of CAD was 81.6% ,77.2%, specificity was 84.5% ,70.7%, and positive predictive value was 91.2% and 83.8%. When these 2 parameters were combined, the sensitivity,specifity and positive pre- dictive value was 76.3% ,87.9% 和 92.6%. Conclusion The extension of QRS duration and depression of ST are reliable parameters in the prediction of CAD. When these 2 parameters were combined , the specifity and positive predictive value in the diagnosis of CAD can be increased.

关 键 词：活动平板运动试验 QRS时限延长 冠心病患者 诊断价值 阳性预测值 冠状动脉造影术 QRs时限延长 ST段下移 

分 类 号：R541.4[医药卫生—心血管疾病] R735.7[医药卫生—内科学]