应用欧洲心脏病学会标准对运动员心电图进行筛查的研究  

Abnormal electrocardiographic patterns in trained athletes screened by European Society of Cardiology recommendations

作　　者：冯莉[1] 冉玉琴[2] 李宁[2] 张建强[1] 马云[3] 马长生[1] 浦介麟[2] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院病理与生理实验中心,北京100037 [3]国家体育总局运动医学研究所体育医院,北京100763

出　　处：《中国心脏起搏与心电生理杂志》2015年第2期106-111,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的对我国部分专业运动员进行心电图筛查,探讨目前心电图筛查标准的合理性。方法入选国家队运动员175例及性别、年龄匹配的大学生运动员305例。同时入选年龄性别匹配的183例普通大学生为对照。记录静息12导联心电图,按照欧洲心脏病学会(ESC)运动员心电图筛查标准进行筛查。结果依据2005年ESC心电图标准筛查发现窦性心动过缓、Ⅰ度或Ⅱ度房室传导阻滞、束支传导阻滞及V5或V6导联R波振幅≥3 m V者发生率专业运动员显著高于大学生运动员和大学生对照(P<0.001)。专业运动员及大学生运动员心电图ST段,T波异常显著高于对照(P均<0.05)。运动员中127例(72.57%),大学生运动员中196例(64.26%),大学生66例(36.07%)心电图中存在两个导联以上ST段压低或T波低平、倒置。依据2010ESC运动员心电图标准筛查发现,除不完全右束支传导阻滞各组间无显著差异外,常见并与运动相关心电图改变各指标三组间均差异显著。少见并与运动不相关异常心电图指标中,除电轴右偏/左后分支阻滞和完全性右/左束支传导阻滞三组差异显著外(P<0.05),其余各项指标三组间无显著差异。结论 2005年ESC心电图标准多项指标与运动强度相关,心电图筛查检出运动员猝死高危者特异性差;2010年ECS少见心电图异常标准中仅电轴右偏/左后分支阻滞和完全性右/左束支传导阻滞与运动强度相关。认为新ESC心电图标准提高了在运动员心电图中筛查的准确性。Objective In 2005, the European Society of Cardiology （ESC） published recommendations for cardiovas- cular screening in athletes and 2010 ESC interpret 12-lead electrocardiogram of athlete in detail. This study aimed to screen young athletes with different training intense with 12 leads ECG criteria of ESC recommendation. Methods ECGs of 175 highly trained young athletes [ 113 males, age （22.9 ±4.7 ） years ], 305 sport college student athletes [ 229 males, age （21.1±1.9） years] and 183 controls [ 111 males, age （21.7±1.8） years] were studied. The ECGs were screened ac- cording to 2005 ESC recommendation and 2010 ESC criteria, and the performance of the 2010 criteria was compared with the 2005 criteria. Results ECG screening with 2005 ESC recommendation showed ST-segment depression, T-wave flattening or inversion was the most obviously ECG changes in trained athletes and student athletes compared to the control （highly trained athletes： 72.57% ; student athletes： 64.26% ; vs. control： 36.07%, both P〈 0.05）. 2010 ESC criteria classified the ECG changes into physiological and pathological changes. In physiological changes except incomplete Right bundle branch block（ RBBB ） other ECG changes, all other ECG criterias were significantly different between three groups, and the rate of these abnormalities correlated with training intense（P〈0. 001 ）. In pathologicalchanges only Right-axis deviation/left posterior hemiblock and complete left bundle branch block（ LBBB ） or RBBB were significantly differently between three groups （ P〈0.05 ）. Conclusion Abnormal ECG patterns of highly trained athlete may caused by cardiac adaptation of systematical physical train- ing and latent cardiac disease, and it is very important to diagnose and differentiate these two conditions. 2010 ESC inter- pretation of athlete ECG can classify abnormal ECG patterns into physiological and pathological changes and improve the accuracy of ECG screening of athletes.

关 键 词：心血管病学 运动员 心电图 运动性猝死 心脏性猝死 

分 类 号：R541.78[医药卫生—心血管疾病] R540.41[医药卫生—内科学]