联合应用心电图和超声心动图在心肌淀粉样变诊断中的价值  

Diagnostic value of combined indexes of electrocardiography and echocardiography in cardiac amyloidosis

作　　者：冀晋[1] 方理刚[1] 方全[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院心内科,100730

出　　处：《中国心血管杂志》2015年第1期46-51,共6页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨心电图和超声心动图联合应用在诊断心肌淀粉样中的价值。方法入选2006年至2013年之间在北京协和医院住院期间诊断为心肌淀粉样变(CA)的患者61例,此外入选肥厚型心肌病(HCM)13例,高血压17例以及健康体检者43例。收集病历资料,进行心电图和超声心动图相关参数测定。结果 CA组肢导联低电压发生率60.7%,余3组均为0%(均为P<0.01),胸导联R波进展不良发生率CA组高于高血压和健康组(47.5%比11.8%,47.5%比11.6%,均为P<0.01),CA组左室射血分数低于其他3组[(54.31%±15.00%)比(69.55%±10.50%)、(54.31%±15.00%)比(63.82%±9.80%)、(54.31%±15.00%)比(69.07%±5.88%),均为P<0.01]。CA组室间隔的厚度小于HCM组[(13.40±2.47)mm比(18.00±5.65)mm,P<0.01],左室后壁厚度大于HCM组[(13.45±2.19)mm比(10.88±3.05)mm,P<0.01],CA组室间隔与左室后壁的厚度与高血压组相比差异无统计学意义[(13.40±2.47)mm比(14.05±3.05)mm、(13.45±2.19)mm比(14.00±2.58)mm,均为P>0.05]。CA组肢导联及胸导联最高电压均小于其他3组(均为P<0.01);与HCM或高血压组比较,CA组所有12导联的QRS波电压值、Ⅰ、a VL和V5、V6导联R波与左室后壁,或与室间隔的比值均较低(均为P<0.01)。与健康组比较,CA组QRS波电压值除a VL、V2导联外,其他导联电压均较低(均为P<0.01);CA组Ⅰ、V5、V6导联R波与左室后壁或室间隔比值均低于健康组(均为P<0.01)。应用ROC曲线得出RⅠ/LVPW曲线下面积最大,当RⅠ/LVPW<0.36时,其诊断CA的敏感度和特异度最佳,分别为96.7%和88.5%。结论心电图和超声心动图检查参数结合,对心肌淀粉样变的辅助诊断和鉴别诊断有很好的临床价值,RⅠ/LVPW具有很高的敏感度和特异度。Objective To investigate the diagnostic value of combination of electrocardiography （ECG）and echocardiography （ECHO）in patients with cardiac amyloidosis （CA）. Methods A total of 61 patients diagnosed with CA in Peking Union Medical College hospital from 2006 to 2013 were included. 13 patients with hypertrophic cardiomyopathy （ HCM） , 17 with hypertension （ HTN） and 43 healthy cases were enrolled as control groups. The ECG and ECHO characteristics of these cases were analyzed. Results Incidence of low voltage of limb leads was significantly higher in CA group compared with other three groups （60. 7% vs. 0%,all p 〈0. 01）. Incidence of poor progress of R wave in chest leads in CA group was significantly higher than HTN and health groups （47. 5% vs. 11. 8%,47. 5% vs. 11. 6%,both p〈0. 01）. Patients in CA group had the poorest left ventricular ejection fraction [（54. 31% ± 15. 00%）vs. （69. 55%± 10. 50%） , （ 54. 31% ± 15. 00%） vs. （ 63. 82% ± 9. 80%） , （ 54. 31% ± 15. 00%） vs. （ 69. 07% ±5. 88% ）,all p〈0. 01]. The septal left ventricular wall thickness was significantly lower in CA group than in HCM group [（13. 40 ± 2. 47）mm vs. （18. 00 ± 5. 65）mm,p〈0. 01]. The posterior left ventricular wall thickness was significantly higher in CA group than in HCM group [ （ 13. 45 ± 2. 19 ） mm vs. （ 10. 88 ± 3. 05）mm,p〈0. 01]. No significant difference between CA and HTN groups for the septal and posterior left ventricularwallthickness[（13.40±2.47）mmvs. （14.05±3.05）mm,（13.45±2.19）mmvs. （14.00 ±2. 58）mm,both p 〉0. 05]. The voltages in all 12 leads ECG and the combined indexes of ECG and ECHO parameters,including the ratio of RI/LVPW,RaVL/LVPW,RV5/LVPW,RV6/LVPW as well as RI/IVS,RaVL/IVS,were significantly lower in CA group than in HTN and HCM groups （all p〈0. 01）. The ROC curve analysis showed RI/LVPW had the maximum area and the ratio of RI/LVPW〈0. 36 had the optimal sensitivity of 96. 7% and specificity of 88. 5%. Co

关 键 词：心肌疾病 淀粉样变性 心电图 超声心动图 

分 类 号：R540.4[医药卫生—心血管疾病] R597.2[医药卫生—内科学]