室速积分法对预激性心动过速的诊断价值  

Value of ventricular tachycardia score in diagnosing pre-excited tachycardia

作　　者：汪文娟[1] 李予[2] 张敏[1] 刘春花[1] 郭惠玲[2] 杨华[3] 向芝青 蒋勇 赵学辉[3] 郭继鸿[5] WANG Wenjuan;LI Yu;ZHANG Min;LIU Chunhua;GUO Huiling;YANG Hua;XIANG Zhiqing;JIANG Yong;ZHAO Xuehui;GUO Jihong(Department of Cardiology,Third Xiangya Hospital,Central South University,Changsha 410013;Department of CardiopulmonaryFunction,Hunan Cancer Hospital,Changsha 410013;Department of Cardiology,Hunan Provincial People's Hospital,Changsha 410002;Department of Heart Function Examination,Xiangxi Tujia and Miao Autonomous Prefecture People's Hospital,Jishou Hunan 416000;Department of Cardiology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]中南大学湘雅三医院心内科,长沙410013 [2]湖南省肿瘤医院心肺功能科,长沙410013 [3]湖南省人民医院心内科,长沙410002 [4]湘西土家族苗族自治州人民医院心功能检查科,湖南吉首416000 [5]北京大学人民医院心内科,北京100044

出　　处：《中南大学学报（医学版）》2019年第9期1041-1047,共7页Journal of Central South University ：Medical Science

摘　　要：目的:探讨室速积分法诊断预激性心动过速的临床价值。方法:选取30例经过心内电生理检查确诊的预激性心动过速发作时的12导联心电图,首先用室速积分法对预激性心动过速进行评分,采用室速积分法的7项指标分析预激性心动过速的心电图,计算7项指标及无人区电轴的特异度;对比分析积分值为2,Brugada,Wellens及Vereckei流程法诊断预激性心动过速的差异。再依照特异度从低到高的顺序用Vereckei,Wellens及Brugada流程法,室速积分法逐步排除室性心动过速(ventricular tachycardia,VT),比较各步骤诊断预激性心动过速的差异。结果:在单项指标中,房室分离、无人区电轴特异度最高,均为100%;室速积分法分值≥3特异度为100%;室速积分法分值为2的特异度高于Brugada,Wellens或Vereckei流程法(76.7%vs50.0%,23.3%,20.0%;均P<0.05)。用Vereckei,Wellens及Brugada流程法,室速积分法逐步排除VT后其特异度(20.0%,40.0%,66.7%,83.3%)高于单用Vereckei或前3种联合排除(P<0.001);但经4种方法排除后剩下的假阳性病例与单一用室速积分法诊断的假阳性病例比较差异无统计学意义(P>0.05)。结论:室速积分法分值≥3可完全鉴别预激性心动过速与VT。室速积分法分值为2不能完全区分预激性心动过速与VT,但其特异度明显高于Brugada,Wellens及Vereckei流程法。Objective: To investigate the value of ventricular tachycardia(VT) score in diagnosing pre-excited tachycardia.Methods: Twelve-lead electrocardiograph results were obtained from 30 patients at pre-excited tachycardia attacking stage who were diagnosed by electrophysiology. We scored pre-excitation tachycardia based on the VT score. To analyze the electrocardiogram of pre-excited tachycardia using 7 diagnostic indicators of the VT score and calculate the specificity of 7 diagnostic indicators and right superior axis(–90° to ±180°), the differences were compared among VT score of 2 points and brugada, Wellens, and Vereckei algorithms in diagnosing pre-excited tachycardia. According to the specificity of Vereckei, Wellens, and Brugada algorithms, and VT scores from low to high, their prediction value and differences were analyzed.Results: Single indicator such as atrioventricular(AV) dissociation or right superior axis(–90° to ±180°) showed the highest specificity(100%) for identifying pre-excited tachycardia. No patient with VT score was ≥3 points, and the specificity was 100%. The specificity of VT score of 2 point was higher than that of Brugada, Wellens, or Vereckei algorithms in the diagnosing pre-excited tachycardia(76.7% vs 50.0%, 23.3% or 20.0%, P<0.05). The specificity of Vereckei, Wellens, and Brugada algorithms and VT score were gradually increased after each of stepwise individually eliminated VT(20.0%, 40.0%, 66.7%, 83.3%, P<0.05). However, there was no significant difference in the specificity in the remaining false positive cases between the 4 methods and VT score.Conclusion: VT score ≥3 points can identify pre-excited tachycardia and VT with 100% specificity. VT score of 2 points cannot completely distinguish pre-excited tachycardia from VT, but specificity of VT score with 2 points is obviously higher than that of Brugada, Wellens, and Vereckei algorithms.

关 键 词：预激性心动过速 室速积分法 房室分离 无人区电轴 Brugada流程法 Wellens流程法 Vereckei流程法 

分 类 号：R541.71[医药卫生—心血管疾病]