冠状动脉粥样硬化性心脏病患者碎裂QRS波的分布特征及其与左心室重构的关系  

Distribution characteristics of fragmented QRS in patients with coronary atherosclerotic heart disease and its relationship with left ventricular remodeling

作　　者：苏海霞[1] 朱雅琴[1] 张天贶 张绘莉[1] 顾俊[1] SU Hai-xia;ZHU Ya-qin;ZHANG Tian-kuang;ZHANG Hui-li;GU Jun(Department of Cardiovascular Medicine,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院心血管内科

出　　处：《上海交通大学学报（医学版）》2019年第10期1162-1166,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金（81570037）;上海市科学技术委员会医学引导类（西医）科技支撑项目（19411963300）~~

摘　　要：目的·探讨碎裂QRS波(fragmented QRS,fQRS)对冠状动脉粥样硬化性心脏病(冠心病)的诊断价值,并分析其与左心室重构的关系。方法·选择2016年11月—2018年10月于上海交通大学医学院附属第九人民医院心血管内科住院期间行冠状动脉造影检查的患者498例,根据造影检查结果将患者分为对照组(203例,冠状动脉造影为阴性或狭窄<30%)、轻中度狭窄组(155例,冠状动脉狭窄为30%~75%)和重度狭窄组(140例,冠状动脉狭窄≥75%),采用R×C列联表χ^2检验比较3组患者常规心电图fQRS阳性[fQRS(+)]的发生率。将230例狭窄≥30%的单支病变患者按照受累血管分为前降支病变组(128例)、右冠病变组(59例)和回旋支病变组(43例),采用非参数检验法分析fQRS(+)导联与病变血管的关系。最后,将所有入组患者分为fQRS(+)组(86例)和fQRS阴性[fQRS(-)]组(412例),采用二元Logistic回归模型分析fQRS与左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)、室间隔厚度(interventricular septum thickness,IVST)和左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)的相关性。结果·R×C列联表χ^2检验显示,3组患者fQRS(+)的发生率分别为8.89%、16.13%和30.71%,差异具有统计学意义(均P<0.05)。非参数检验结果显示,230例单支病变患者前壁导联(V3、V4)fQRS多出现于前降支病变组,下壁和右心室导联(Ⅱ、Ⅲ、AVF、V1、V2)fQRS多出现于右冠病变组,高侧壁导联(Ⅰ、AVL)fQRS多出现于回旋支病变组,差异具有统计学意义(均P<0.05)。二元Logistic回归分析显示,fQRS与LVEF呈负相关(r=-0.030,OR=0.971,95%CI为0.945~0.997,P=0.029),与LVESV呈正相关(r=0.042,OR=1.043,95%CI为1.005~1.082,P=0.026)。结论·fQRS对冠心病的临床诊断有一定的参考价值,左心室重构可能是fQRS发生的机制之一。Objective·To explore the diagnostic value of fragmented QRS(fQRS)for coronary atherosclerotic heart disease(CHD),and to analyze it's relationship with left ventricular remodeling.Methods·From Nov.2016 to Oct.2018,498 hospitalized patients in the Department of Cardiovascular Medicine of Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine were selected consecutively.During the hospitalization,all the patients underwent coronary angiography.According to the angiographic results,the patients were divided into the control group(203 patients with negative or coronary stenosis<30%),the mild to moderate stenosis group(155 patients with coronary stenosis 30%to 75%),and the severe stenosis group(140 patients with coronary stenosis≥75%).The incidences of fQRS(+)in the normal electrocardiogram among the three groups were compared by chisquare test of R×C contingency table.Two hundred and thirty patients with single-vessel stenosis≥30%were divided into the anterior descending branch group(128 cases),the right coronary branch group(59 cases),and the circumflex branch group(43 cases),and the relationship between fQRS(+)leads and diseased vessels was analyzed by nonparametric test.Finally,all the patients were divided into fQRS(+)group(86 cases)and fQRS(-)group(412 cases).The correlation between fQRS and left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),interventricular septum thickness(IVST)and left ventricular posterior wall thickness(LVPWT),respectively,were analyzed by binary Logistic regression model.Results·The chi-square test of R×C contingency table showed that the incidences of fQRS(+)in the three groups were 8.89%,16.13%and 30.71%,respectively,with statistically significant differences(all P<0.05).The nonparametric test showed that the fQRS(+)leads reflecting the anterior wall(V3,V4)were more common in the anterior descending branch group,and the fQRS(+)leads reflecting the interior wall and right vent

关 键 词：碎裂QRS波 冠状动脉造影 冠心病 左心室重构 

分 类 号：R541.4[医药卫生—心血管疾病]