肥厚性心肌病患者检测跨室壁复极离散度的意义  

Clinical significance of detecting transmural dispersion of repolarization in patients with hypertrophic cardiomyopathy

作　　者：蒋玲玲 石菲菲[1] 李晓东[2] Jiang Lingling;Shi Feifei;Li Xiaodong(Department of Cardiology Function, Shengjing Hospital of China Medical University, Shenyang 110004, China;Department of Cardiology, Shengjing Hosipital of China Medical University, Shenyang 110004, China)

机构地区：[1]中国医科大学附属盛京医院心功能科,沈阳110004 [2]中国医科大学附属盛京医院心内科,沈阳110004

出　　处：《中国医师进修杂志》2019年第5期407-410,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨跨室壁复极离散度在肥厚性心肌病(HCM)患者中的变化及临床意义。方法选择中国医科大学附属盛京医院2015年1月至2017年10月72例HCM患者(观察组)和72例健康体检者(对照组)。两组均行12导联常规心电图检查,测量T波峰末间期(TpTe)、校正QT间期(QTc)、QT间期离散度(QTd)和TpTe/QTc。观察组行24h动态心电图检查,根据结果分为室性心律失常亚组和无室性心律失常亚组,并比较TpTe、QTc、QTd和TpTe/QTc。结果观察组TpTe、QTc、QTd和TpTe/QTc均明显高于对照组[(112.5±11.2)ms比(105.6±9.2)ms、(396.5±13.5)ms比(385.3±12.5)ms、(36.5±6.4)ms比(32.4±5.4)ms和0.289±0.016比0.262±0.015],差异有统计学意义(P<0.05)。观察组患者24h动态心电图检查结果显示,有室性心律失常47例(有室性心律失常亚组),无室性心律失常患者25例(无室性心律失常亚组)。室性心律失常亚组TpTe、QTc、QTd和TpTe/QTc明显高于无室性心律失常亚组[(114.4±14.5)ms比(110.3±12.2)ms、(402.5±15.2)ms比(392.0±12.1)ms、(37.5±6.2)ms比(35.4±6.5)ms和0.292±0.016比0.285±0.015],差异有统计学意义(P<0.05)。结论TpTe、QTc、QTd和TpTe/QTc反映了HCM患者跨室壁复极离散度的增大,对室性心律失常有一定的预测作用。Objective To explore the changes and clinical significance of transmural dispersion of repolarization (TDR) in patients with hypertrophic cardiomyopathy (HCM). Methods Seventy-two patients with HCM (observation group) and 72 healthy subjects (control group) in Shengjing Hospital of China Medical University were selected from January 2015 to October 2017. The 12-lead conventional electrocardiogram was performed on enrolled personnel in 2 groups to measure T-peak T-end (TpTe), correct the QT interval (QTc), QT interval dispersion (QTd) and TpTe/QTc. The observation group underwent 24 h dynamic electrocardiography. The patients were divided into ventricular arrhythmia subgroup and non-ventricular arrhythmia subgroup according to the results of 24 h dynamic electrocardiography, and the TpTe, QTc, QTd and TpTe/QTc were compared. Results The TpTe, QTc, QTd and TpTe/QTc in observation groups were significantly higher than those in control group:(112.5 ± 11.2) ms vs.(105.6 ± 9.2) ms,(396.5 ± 13.5) ms vs.(385.3 ± 12.5) ms,(36.5 ± 6.4) ms vs.(32.4 ± 5.4) ms and 0.289 ± 0.016 vs. 0.262 ± 0.015, and there were statistical differences (P<0.05). In observation group, the 24 h dynamic electrocardiogram result showed that 47 patients had ventricular arrhythmia (ventricular arrhythmia subgroup) and 25 patients had not ventricular arrhythmia (non-ventricular arrhythmia subgroup). The TpTe, QTc, QTd and TpTe/QTc in ventricular arrhythmia subgroup were significantly higher than those in non-ventricular arrhythmia subgroup:(114.4 ± 14.5) ms vs.(110.3 ± 12.2) ms,(402.5 ± 15.2) ms vs.(392.0 ± 12.1) ms,(37.5 ± 6.2) ms vs.(35.4 ± 6.5) ms and 0.292 ± 0.016 vs. 0.285 ± 0.015, and there were statistical differences (P<0.05). Conclusions The values of TpTe, QTc, QTd and TpTe/QTc reflect the increase of transmural dispersion of repolarization in patients with HCM, and have a certain predictive effect on ventricular arrhythmia.

关 键 词：心肌病 肥厚性 T波峰末间期 室性心律失常 

分 类 号：R542.2[医药卫生—心血管疾病]