心电图对心尖肥厚型心肌病的诊断价值  

Value of electrocardiogram to the diagnosis of apical hypertrophic cardiomyopathy

作　　者：邓园园[1] 陶炜伟[1] 龚帆影[1] 司徒秋顺[1] 蒋卫民[2] DENG Yuanyuan;TAO Weiwei;GONG Fanying;SITU Qiushun;JIANG Weimin(Department of Functional Medicine,Jiangsu Hospital of Traditional Chinese Medicine,Nanjing 210029,China;Hypertension Institute,Jiangsu Hospital of Traditional Chinese Medicine,Nanjing 210029,China)

机构地区：[1]江苏省中医院功能检查科,南京210029 [2]江苏省中医院高血压研究所,南京210029

出　　处：《中华实用诊断与治疗杂志》2020年第12期1270-1273,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：江苏省中医院面上项目(Y18012);江苏省科技发展计划项目(BE2017775)。

摘　　要：目的分析心尖肥厚型心肌病(apical hypertrophic cardiomyopathy,AHCM)患者心电图各波形的特征,探讨AHCM患者心电图特异性指标及定位价值。方法经二维超声心动图确诊的AHCM患者81例为AHCM组,高血压性左心室肥厚(hypertensive left ventricular hypertrophy,H-LVH)患者42例为H-LVH组,心脏结构正常者32例为对照组,比较3组心电图相关指标。结果AHCM组合并心律失常、T波电轴偏移发生率(37.0%、82.7%)高于H-LVH组(21.4%、0)和对照组(3.1%、0)(P<0.05),QTc时限[(408.80±37.65)ms]短于H-LVH组[(425.76±28.68)ms]和对照组[(413.91±17.09)ms](P<0.05),H-LVH组与对照组比较差异无统计学意义(P>0.05)。AHCM组Ⅰ、aVL、V3、V4、V5、V6导联ST段下移发生率(54.3%、32.1%、48.1%、75.3%、84.0%、79.0%)高于H-LVH组(2.4%、0、2.4%、4.8%、7.1%、19.0%)和对照组(3.1%、3.1%、0、3.1%、9.4%、3.1%)(P<0.05),H-LVH组V6导联ST段下移发生率高于对照组(P<0.05)。AHCM组V4、V5、V6导联R波振幅增高发生率(66.7%、70.4%、40.7%)高于H-LVH组(16.7%、19.0%、7.1%)和对照组(0、0、0)(P<0.05),H-LVH组V4、V5导联R波振幅增高发生率高于对照组(P<0.05)。AHCM组Ⅰ、aVL、V3、V4、V5、V6导联T波倒置发生率(53.1%、51.9%、80.2%、86.4%、86.4%、85.2%)高于H-LVH组(7.1%、14.3%、2.4%、4.8%、7.1%、7.1%)和对照组(0、9.4%、3.1%、3.1%、3.1%、3.1%)(P<0.05),H-LVH组与对照组比较差异无统计学意义(P>0.05)。结论AHCM患者早期心电图特异性改变主要表现为V4~V6导联R波振幅增高,Ⅰ、aVL、V3~V6导联ST段下移及T波深倒置;高血压伴有QTc时限延长可能提示H-LVH,可作为与AHCM的鉴别诊断,对临床建立心电图定位诊断有参考价值。Objective To analyze the characteristics of electrocardiogram(ECG)waveforms in patients with apical hypertrophic cardiomyopathy(AHCM),and to investigate the specific indexes and location value of ECG in patients with AHCM.Methods Eighty patients with AHCM(AHCM group)and 42 patients with hypertensive left ventricular hypertrophy(H-LVH)(H-LVH group)were diagnosed by two-dimensional echocardiography,and another 32 patients with normal cardiac structure were as controls(control group).The ECG related indexes were analyzed in three groups.Results The incidences of arrhythmia and T-wave axis deviation were higher in AHCM group(37.0%,82.7%)than those in H-LVH group(21.4%,0)and control group(3.1%,0)(P<0.05).QTc duration was shorter in AHCM group((408.80±37.65)ms)than that in H-LVH group((425.76±28.68)ms)and control group((413.91±17.09)ms)(P<0.05),and showed no significant difference between H-LVH group and control group(P>0.05).The incidences of ST-segment depression in lead Ⅰ,aVL,V3,V4,V5 and V6 were higher in AHCM group(54.3%,32.1%,48.1%,75.3%,84.0%,79.0%)than those in H-LVH group(2.4%,0,2.4%,4.8%,7.1%,19.0%)and control group(3.1%,3.1%,0,3.1%,9.4%,3.1%)(P<0.05),the incidence of ST-segment depression in lead V6 was higher in H-LVH group than that in control group(P<0.05).The incidences of increased R-wave amplitude in lead V4,V5 and V6 were higher in AHCM group(66.7%,70.4%,40.7%)than those in H-LVH group(16.7%,19.0%,7.1%)and control group(0,0,0)(P<0.05),and the incidences of increased R-wave amplitude in lead V4 and V5 were higher in H-LVH group than those in control group(P<0.05).The incidences of T-wave depth inversion in lead Ⅰ,aVL,V3,V4,V5 and V6 were higher in AHCM group(53.1%,51.9%,80.2%,86.4%,86.4%,85.2%)than those in H-LVH group(7.1%,14.3%,2.4%,4.8%,7.1%,7.1%)and control group(0,9.4%,3.1%,3.1%,3.1%,3.1%)(P<0.05),and showed no significant differences between H-LVH group and control group(P>0.05).Conclusion The early changes of ECG in AHCM patients include the increase of R-wave amplitude in lead V4 to V6,S

关 键 词：心尖肥厚型心肌病 高血压性左心室肥厚 心电图 超声心动图 

分 类 号：R540.41[医药卫生—心血管疾病] R542.2[医药卫生—内科学]