心电图的多元参考值范围研究及临床评价  

Study on the multivariate reference range of ECG and clinical evaluation

作　　者：郑坤[1] 石增立[2] 徐天和[3] 孙红卫[3] 

机构地区：[1]滨州医学院病理生理学教研室,烟台市264003 [2]潍坊医学院 [3]滨州医学院统计学教研室

出　　处：《滨州医学院学报》2011年第3期201-204,共4页Journal of Binzhou Medical University

基　　金：山东省科学技术发展计划(2005GG3202163)

摘　　要：目的为了更好地利用心电图丰富的数据进行疾病诊断,试建立正常人心电图的多元参考值范围,并选取左心室肥厚(LVH)心电图和正常人心电图数据对其进行临床评价。方法选择正常成年人心电图1 021例(男244例,女777例),分性别用统计深度函数MHD法建立R波及R+S波振幅的多元参考值范围。选取81例(男性42例,女性39例)诊断为LVH的心电图作为病例组,50例正常成年人(男性25例,女性25例)心电图作为对照组,根据建立的多元参考值范围进行诊断试验评价。结果 (1)建立正常人心电图R波和R+S波振幅在12导联95%的参考值范围:正常成年男性、女性心电图的R波振幅在12导联95%的参考值范围分别为统计深度Depth≥0.033 692 3、Depth≥0.030 350 4;R+S波振幅12导联95%的参考值范围分别为统计深度Depth≥0.021 772 5、Depth≥0.016 241 5。通过计算得出病例组和正常组心电图R波和R+S波振幅在12导联的统计深度值。(2)诊断试验:运用统计深度函数法对R波振幅判断的敏感性为95.06%,特异性为98%,正确率为96.18%;统计深度函数法对R+S波振幅判断的敏感性为92.59%,特异性为98%,正确率为94.66%。结论运用统计深度函数MHD法来全面判断心电图某波振幅是否过高或过低,是一种可为临床心电图诊断提供参考的新方法,具有进一步探索和研究的价值。Objective To make better use of the data of ECG,try to establish a multivariate reference range of normal ECG and choose a group of abnormal and common ECG which were diagnosed as left ventricular hypertrophy（LVH）to make a clinical evaluation.Methods 1 021（male 244,female 777）normal ECG were chosed and MHD was used to establish a multivariate reference range for the R-wave amplitude and R＋S wave amplitude of normal ECG according to gender,and 81 ECG（male 42,female 39）which were diagnosed as LVH were chosed as the case group,50 normal ECG（male 25,female 25）as the control group,MHD was used to calculate their statistics depth values about and compare the special indicators with the multivariate reference range of the R-wave amplitude and R＋S wave amplitude of normal ECG,to study the sensibility,specificity and accuracy of MHD about wave amplitude judgment of ECG.Results（1）The multivariate reference range for R-wave amplitude and for R＋S wave amplitude of normal adult ECG has been established as follows：R-wave amplitude of normal adult male：a 95% CI of multivariate reference range Depth≥0.033 692 3,female Depth≥0.030 350 4.R＋S wave amplitude of normal adult male：a 95% CI of multivariate reference range Depth≥0.021 772 5,female Depth≥0.016 241 5.Mahalanobis depth function of the R-wave amplitude and R＋S wave amplitude of the case group and the control group has always been calculated.（2）Diagnostic test：the sensibility,specificity and accuracy to R-wave amplitude of MHD were 95.06%,98% and 96.18%.The sensibility,specificity and accuracy to R-wave amplitude of MHD were 92.59%,98% and 94.66%.Conclusions The method MHD which can judge whether some wave amplitude of one ECG is higher or lower is a new method to make a better clinical ECG diagnostication.

关 键 词：心电图 振幅 多元参考值范围 统计深度函数 左心室肥厚 

分 类 号：R540.4[医药卫生—心血管疾病]