慢性阻塞性肺疾病和哮喘急性发作患者心电图额面P电轴垂直化的观察研究  

Verticalization of frontal P axis on electrocardiography in patients with acute exacerbation of chronic obstructive pulmonary disease and asthma

作　　者：李维浩[1] 曹惠芳[1] 冯莹[1] 潘玉婷 朱惠莉[2] Li Weihao;Cao Huifang;Feng Ying;Pan Yuting;Zhu Huili(Department of Respiratory and Critical Care Medicine,Jing′an District Central Hospital of Shanghai,Shanghai 200040,China;Department of Respiratory and Critical Care Medicine,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]上海市静安区中心医院呼吸与危重症医学科,200040 [2]复旦大学附属华东医院呼吸与危重症医学科,上海200040

出　　处：《中华全科医师杂志》2020年第1期32-36,共5页Chinese Journal of General Practitioners

基　　金：上海市静安区卫生计生系统十百千卫生人才培养项目(JWRC2014G02)。

摘　　要：目的探讨心电图额面P电轴垂直化在慢性阻塞性肺疾病和支气管哮喘急性发作住院患者中的表现及其临床意义。方法回顾2014年1月至2016年6月上海市静安区中心医院住院、1周内完成12导联心电图、肺功能和肺高分辨率CT的患者的临床资料,按相同的年龄、性别比例顺序选取慢性阻塞性肺疾病急性发作患者35例和支气管哮喘急性发作患者20例,同时选取无慢性肺部疾病的健康体检者20例为对照组。分析3组患者的P电轴、肺功能与CT肺气肿评分的差异,并评估P电轴垂直化与肺功能和CT肺气肿评分的相关性。结果3组P电轴(F=24.36)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)(F=39.36)、FEV1(F=28.82)、FEV1占预计值百分比(FEV1%)(F=30.64)、用力肺活量占预计值百分比(FVC%)(F=3.45)、呼气峰流速占预计值百分比(PEF%)(F=13.22)、残气量与肺总量比值(RV/TLC)(F=10.46)以及总肺气肿评分(F=50.60)的差异均有统计学意义(均P<0.01)。P电轴与年龄(r=0.229)、总肺气肿评分(r=0.567)、上肺气肿评分(r=0.542)、中肺气肿评分(r=0.507)、下肺气肿评分(r=0.572)呈正相关(均P<0.05),与BMI(r=-0.491)、心胸比例(r=-0.396)、FEV1/FVC(r=-0.609)、FEV1(r=-0.389)、FEV1%(r=-0.460)、PEF%(r=-0.419)呈负相关(均P<0.01)。以P电轴>60°为P电轴垂直化标准筛查慢性阻塞性肺疾病的敏感性为0.938,特异性为0.667,阳性预测值为0.833,阴性预测值为0.857。结论额面P电轴垂直化与阻塞性通气障碍相关,与CT肺气肿评分相关,可能作为基层医疗机构中慢性阻塞性肺疾病的初步筛查指标。Objective To investigate the clinical significance of verticalization of frontal P axis on electrocardiagraphy(ECG)in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)and asthma.Methods Thirty five COPD patients and 20 asthma patients with acute exacerbation admitted in Jing′an District Central Hospital were enrolled and 20 health subjects served as a control group.The 12 lead ECG examination,pulmonary function test and high resolution CT(HRCT)scan of lung were performed.The P axis in ECG,pulmonary function and CT emphysema score were compared among three groups.The correlation of P axis verticalization with pulmonary function and CT emphysema score was analyzed.Results There were significant differences in P axis(F=24.36),FEV1/FVC(F=39.36),FEV1(F=28.82),FEV1%(F=30.64),FVC%(F=3.45),PEF%(F=13.22),RV/TLC(F=10.46)and total emphysema score(F=50.60)among the three groups(all P<0.01).P axis was positively correlated with age(r=0.229),total emphysema score(r=0.567),upper lung emphysema score(r=0.542),middle lung emphysema score(r=0.507),lower lung emphysema score(r=0.572)(all P<0.01),and negative correlation with body mass index(r=-0.491),cardiothoracic ratio(r=-0.396),FEV1/FVC(r=-0.609),FEV1(r=-0.389),FEV1%(r=-0.460),and PEF%(r=-0.419)(all P<0.01).Taking P axis>60°as cut-off value for screening COPD,the sensitivity was 0.933,specificity was 0.667,positive predictive value was 0.833 and negative predictive value was 0.857.Conclusion The verticalization of frontal P axis on ECG is significantly associated with obstructive ventilation disorder and CT emphysema score,which can be used as a preliminary screening index for COPD.

关 键 词：肺疾病 慢性阻塞性 呼吸功能试验 心电描记术 向量心电描记术 肺气肿 

分 类 号：R563[医药卫生—呼吸系统] R54[医药卫生—内科学]