QT离散度和JT离散度对冠心病血瘀证型辨证的指导价值袁永杰,张永军,韩诚正  

Guidance value of QT dispersion and JT dispersion for identification of coronary heart disease with blood stasis syndrome type

作　　者：袁永杰[1] 张永军[1] 韩诚正 YUAN Yong-jie;ZHANG Yong-jun;HAN Cheng-zheng(Department of Cardiac Function,Yijishan Hospital of Wannan Medical College,Wuhu,Anhui,241001,China)

机构地区：[1]皖南医学院弋矶山医院心功能科,安徽芜湖241001 [2]皖南医学院弋矶山医院中西医结合门诊,安徽芜湖241001

出　　处：《心血管康复医学杂志》2019年第6期784-787,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨QT离散度(QTd)和JT离散度(JTd)对冠心病血瘀证型辨证的指导价值。方法:我院的冠心病患者246例,根据望、闻、问、切被分为:瘀血阻滞(71例),痰痹心阳(42例),肝、肾阴虚(44例),气阴两虚(54例),心肾阳虚(35例)等5组,观察患者QTd、校正后QT间期离散度(QTcd)、JTd、校正后JT间期离散度(JTcd)在各证型的水平及其预测瘀血阻滞的价值。结果:与痰痹心阳,肝、肾阴虚,气阴两虚和心肾阳虚证型患者比较,瘀血阻滞证型患者QTd[(72.21±16.48)ms,(50.89±12.77)ms,(49.17±7.91)ms,(62.54±12.80)ms比(82.30±19.05)ms]、QTcd[(73.82±18.72)ms,(51.41±12.81)ms,(51.12±9.73)ms,(62.48±13.35)ms比(87.75±20.72)ms]、JTd[(74.54±16.83)ms,(52.18±12.68)ms,(51.50±10.78)ms,(64.75±12.30)ms比(89.43±24.40)ms]、JTcd[(75.14±21.05)ms,(54.93±11.41)ms,(52.90±10.03)ms,(65.26±12.72)ms比(91.98±24.22)ms]水平均显著升高(P均=0.001)。QTd、QTcd、JTd、JTcd预测冠心病瘀血阻滞的曲线下面积为分别为0.832、0.861、0.856、0.854,最佳截断值分别为70.77ms、69.83ms、77.80ms和77.51ms。结论:冠心病瘀血阻滞证型患者心电图QTd和JTd水平显著高于其他证型,对于指导冠心病辨证分型具有一定临床价值。Objective:To explore the guidance value of QT dispersion(QTd)and JT dispersion(JTd)for identification of coronary heart disease(CHD)with blood stasis syndrome type.Methods:A total of 246 CHD patients of our hospital were divided into blood stasis block group(n=71),Tanbixinyang group(TBXY group,n=42),liver and renal Yin deficiency group(LRYD group,n=44),Qi and Yin deficiency group(QYD group,n=45)and cardiac and renal Yang deficiency group(CRYD group,n=35)according to four diagnostic methods of Traditional Chinese Medicine(TCM).The QTd,corrected QTd(QTcd),JTd and corrected JTd(JTcd)were observed in all groups,and their predictive value for blood stasis block were analyzed.Results:Compared with TBXY,LRYD,QYD and CRYD group,there were significant rise in levels of QTd[(72.21±16.48)ms,(50.89±12.77)ms,(49.17±7.91)ms,(62.54±12.80)msvs.(82.30±19.05)ms],QTcd[(73.82±18.72)ms,(51.41±12.81)ms,(51.12±9.73)ms,(62.48±13.35)msvs.(87.75±20.72)ms],JTd[(74.54±16.83)ms,(52.18±12.68)ms,(51.50±10.78)ms,(64.75±12.30)msvs.(89.43±24.40)ms]and JTcd[(75.14±21.05)ms,(54.93±11.41)ms,(52.90±10.03)ms,(65.26±12.72)msvs.(91.98±24.22)ms]in blood stasis block group,P=0.001 all.Area under curve(AUC)of QTd,QTcd,JTd,JTcd predicting CHD with blood stasis block was 0.832,0.861,0.856 and 0.854 respectively,and optimal cutoff point was 70.77ms,69.83ms,77.80ms and 77.51ms respectively.Conclusion:QTd and JTd levels on ECG in CHD patients with blood stasis block type are significantly higher than other syndrome types,so they possess certain guidance value for CHD syndrome typing.

关 键 词：冠心病 心电描记术 证候 

分 类 号：R541.4[医药卫生—心血管疾病]