P波最大时限与P波离散度对舒张性心力衰竭患者心房颤动由阵发性转为持续性的预测价值  

Value of maximum P-wave duration and P-wave dispersion in predicting progression of paroxysmal atrial fibrillation to persistent atrial fibrillation in patients with diastolic heart failure

作　　者：张明亮[1] 尹鲁骅[1] 杨申[1] 杜玉花[1] 王爱萍[1] 吴云[1] 张焕轶[1] 

机构地区：[1]山东省泰安市中心医院心内科,271000

出　　处：《中国医药》2015年第4期449-453,共5页China Medicine

基　　金：山东省自然科学基金（ZR2011HM001）

摘　　要：目的 探讨P波最大时限与P波离散度对舒张性心力衰竭患者心房颤动由阵发性转为持续性的预测价值.方法 选择2008年6月至2011年4月泰安市中心医院确诊的127例舒张性心力衰竭合并阵发性心房颤动患者,入选时行标准12导联心电图及心脏超声检查,随访2年,观察患者是否发生持续性心房颤动.根据随访结果将患者分为未发生持续性心房颤动组（78例）和发生持续性心房颤动组（49例）.使用多因素Logistic回归模型分析与持续性心房颤动相关的因素.使用受试者工作特征（ROC）曲线下面积判定P波最大时限与P波离散度对持续性心房颤动的预测能力.结果 发生持续性心房颤动患者心电图P波最大时限与P波离散度明显高于未发生持续性心房颤动患者[（110±32）ms比（97±20）ms,（41±20）rns比（28±16）ms],差异均有统计学意义（均P＜0.05）.多因素Logistic回归模型显示P波最大时限与P波离散度均可以独立预测2年内持续性心房颤动的发生,P波最大时限与P波离散度每增加1 ms,患者2年内发生持续心房颤动的风险分别增加1.452及1.805倍.P波最大时限与P波离散度对预测持续性心房颤动的ROC曲线下面积比较（0.688比0.735）,差异无统计学意义（P＞0.05）,二者联合预测的ROC曲线下面积为0.799,均高于二者单独应用,差异有统计学意义（P＜0.05）.结论 P波最大时限与P波离散度对舒张性心力衰竭患者心房颤动由阵发性转为持续性有预测价值,二者联合应用可增强预测能力.Objective To investigate the value of maximum P-wave duration （Pmax） and P-wave disper- sion （Pd） in predicting progression of paroxysmal atrial fibrillation to persistent atrial fibrillation （AF） in patients with diastolic heart failure （HF）. Methods Totally 127 patients with diastolic HF complicated with paroxysmal AF from June 2008 to April 2011 were enrolled. All the patients underwent 12-lead electrocardiography to measure the Pmax and Pd, then were followed up for 2 years to observe the occurrence of persistent AF. The patients were divided into non-persistent AF group （78 cases） and persistent AF group （49） cases according to the follow-up re- suits. Muhivariahle Logistic regression was used to assess related factors of persistent AF and the receiver operating characteristic （ROC） curve was drawn to evaluate the values of Pmax and Pd in predicting persistent AF. Results Compared with non-persistent AF group, Pd and Pmax were both significantly higher in persistent AF group [ （110 ±32） ms vs （97 ±20）ms, （41 ±20）ms vs （28 ± 16）ms, all P〈0. 05]. Multivariable Logistic re- gression showed both Pmax and Pd can independently predict the occurrence of persistent AF in 2 years （ Pmax ： odds ratio 1. 452, 95% confidence interval： 1. 053-2. 003, P 〈0.05, Pd： odds ratio 1. 805, 95% confidence in- terval ： 1. 412- 2. 314, P 〈 0.05 ）. The area under the curve （AUC） of Pmax was 0. 688, which was similar to that of Pd （0. 735, P 〉0.05） , while the AUC of combination of Pmax and Pd was 0. 799, higher than separate application of Pmax and Pd （ both P 〈 0.05 ）. Conclusion Pmax combined with Pd can predict the progression the paroxysmal to persistent AF in patients with diastolic heart failure.

关 键 词：舒张性心力衰竭 P波最大时限 P波离散度 心房颤动 

分 类 号：R541.7[医药卫生—心血管疾病]