心电图对肺动脉高压的诊断价值探讨  

Diagnosis value of electrocardiogram in patients with pulmonary artery hypertension

作　　者：赵勤华[1] 徐希奇[1] 荆志成[1] 孙明利[2] 代立志[1] 吴文汇[1] 蒋鑫[1] 何晶[1] 李云[1] 

机构地区：[1]同济大学附属上海市肺科医院肺循环科,200433 [2]中国医学科学院北京协和医学院阜外心血管病医院内科

出　　处：《中华心血管病杂志》2010年第4期346-349,共4页Chinese Journal of Cardiology

基　　金：上海市2008浦江人才计划（08PJ14086）

摘　　要：目的参照右心导管检查结果，评价常规12导联心电图在肺动脉高压诊断中的应用价值。方法入选超声心动图估测肺动脉收缩压≥36mmHg（1mmHg=0．133kPa）的64例疑诊肺动脉高压患者为研究对象，右心导管检查前30min行12导联心电图检查。根据右心导管检查结果排除肺动脉高压者26例，确诊肺动脉高压者38例（特发性肺动脉高压23例，结缔组织病相关性肺动脉高压15例）。比较两组间心电图参数差异。通过ROC曲线计算心电图各指标诊断肺动脉高压的敏感性、特异性、阳性预测值及阴性预测值。采用Spearman相关性计算肺动脉高压组心电图参数与血液动力学指标相关性。结果心电图诊断右心室肥大的各指标在肺动脉高压组中的发生率显著高于排除肺动脉高压组。I导联S波振幅〉0．21mV、QaS电轴〉87°、Rv1＋Svs〉0．76mV诊断肺动脉高压的敏感性分别为89％、86％、84％，特异性分别为81％、92％、83％。采用Spearman相关性分析显示，QRS电轴与肺动脉平均压的相关性最高（r=0．75，P〈0．001）；Rv1＋Svs与肺血管阻力的相关性最高（r=0．74，P〈0．001）；Rv1＋Svs和I导联S波振幅与心指数相关性较高（r=-0．62，P〈0．001）。结论常规12导联心电图检查在肺动脉高压筛查中有重要价值，I导联S波振幅〉0．21mV、QRS电轴〉87°、Rv1＋Svs〉0．76mV等右心室肥大征象时应考虑到肺动脉高压可能。QRs电轴、Rv1＋Svs以及I导联S波振幅对评估肺动脉高压患者血液动力学受损的严重程度有临床意义。Objectives To analyze the diagnostic value of electrocardiogram （ECG） in patients with pulmonary artery hypertension （PAH） confirmed by fight-heart catheterization （RHC）. Methods A total of 64 patients with suspected PAH [ sPAP≥ 36 mm Hg （1 mm Hg = 0. 133 kPa） estimated by echocardiography] were enrolled in this study. All patients were examined by 12-lead ECG within half an hour before RHC. Results PAH was excluded in 26 patients and confirmed in 38 patients. ECG analysis showed that S amplitude 〉0. 21 mV in lead I , QRS axis 〉 87° ,Rv1 ＋ Svs 〉0. 76 mV were good parameters for diagnosing PAH with sensibility and specificity of 89%, 81% ; 86%, 92% ; 84%, 83%, respectively. QRS axis was positively correlated with mean pulmonary artery pressure （mPAP） （r = 0. 75, P 〈 0. 001 ）, Rv1 ＋ Svs was positively correlated with pulmonary vascular resistance （PVR） （ r = 0. 74, P 〈 0. 001 ）, Rv1 ＋ Svs and S amplitude in lead I was negatively correlated with cardiac index （CI）（r = -0. 62,P 〈0. 001 ）. Conclusion ECG combined with echocardiography are adequate screening tools to rule out the presence of PAH. QRS axis, Rv1＋ Svs and S amplitude in lead I were significantly correlated with hemodynamic parameters derived from RHC in PAH patients.

关 键 词：高血压 肺性 心电描记术 血液动力学过程 

分 类 号：R543[医药卫生—心血管疾病]