心电图鉴别心肌淀粉样变与肥厚型心肌病  

Electrocardiogram in differentiating cardiac amyloidosis and hypertrophic cardiomyopathy

作　　者：张刘燕 程仙[1] 周芳[1] 张海锋[1] 侯小锋[1] 盛燕辉[1] 王晖[1] 李新立[1] 徐东杰[1] 

机构地区：[1]南京医科大学第一附属医院,210029

出　　处：《临床心电学杂志》2016年第1期8-13,共6页Journal of Clinical Electrocardiology

基　　金：家族性肥厚型心肌病家系调查;基因筛查及预后分析项目编号:XK05 200903(NG09)

摘　　要：目的分析心肌淀粉样变及肥厚型心肌病患者心电图参数,获得能够简易快捷地诊断心肌淀粉样变及与肥厚型心肌病相鉴别的诊断流程。方法心肌淀粉样变患者(A组)、肥厚型心肌病患者(C组)、正常对照(B组)各30例,比较心电图参数特征,通过ROC曲线及logistic回归分析心电图参数的诊断价值并提出诊断流程。结果 A组肢体导联及左胸导联(V5、V6)低电压、假性梗死波及胸前导联R波递增不良比例较B组增高。诊断心肌淀粉样变(与B组鉴别):a VR导联QRS振幅(QRSa VR)联合PR间期减去P波时限(PR-P时限):敏感性96.30%,特异性96.67%,正确率96.49%。鉴别心肌淀粉样变与肥厚型心肌病:I导联QRS振幅(QRSI):界值0.46m V,敏感性90.00%,特异性96.67%;QRSa VR:界值0.41m V,敏感性93.33%,特异性93.33%;所有肢体导联QRS电压之和(6∑QRS):界值2.71m V,敏感性96.67%,特异性83.33%。结论心肌淀粉样变心电图多出现肢体导联及左胸导联低电压,假性梗死波,胸前导联R波递增不良等表现。QRSa VR联合PR-P时限可用于筛查心肌淀粉样变。QRSI、QRSa VR、6∑QRS可用于鉴别心肌淀粉样变和肥厚型心肌病。Objective To analyze electrocardiographic（ECG） parameters of patients with cardiac amyloidosis（CA）and hypertrophic cardiomyopathy（HCM）,and to obtain simple and rapid procedures for the diagnosis of CA and its differentiation with HCM. Methods To analysis the ECG of patients with CA（group A）、patients with HCM（group C） and normal control（group B）. Each group contains 30 patients. The diagnostic value of ECG parameters are analyzed by receiver operating characteristics curve（ROC）and logistic regression and the diagnosis procedures are put forward. Results Group A has a higher percentage of low voltage on limb leads and left chest leads,pseudo-infarction wave and poor R wave progression on chest leads than group B. For diagnosis of CA： the combination of QRSa VRand PR-P duration： sensitivity 96.30%, spcificity 96.67%, accuracy 96.49%. For differentiation of CA and HCM： QRSI： cutoff value 0.46 m V, sensitivity 90.00%, specificity 96.67%; QRSa VR： cutoff value 0.41 m V, sensitivity 93.33%, spcificity 93.33%; 6∑QRS： cutoff value 2.71 m V, sensitivity 96.67%, spcificity83.33%. Conclusions ECG of CA often shows low voltage on limb leads and left chest leads（V5,V6）,pseudo-infarction wave, poor R wave progression on chest leads. The combination of QRSa VRand PR-P duration can be used in the screening of CA. QRSI、QRSa VR、6∑QRS can be used in the differentiation of CA and HCM.

关 键 词：心肌淀粉样变 肥厚型心肌病 心电图 

分 类 号：R540.41[医药卫生—心血管疾病] R542.2[医药卫生—内科学]