改良的心电图Cornell标准在诊断高血压左心室构型改变中的价值  

The value of improved electrocardiogram Cornell criteria in diagnosing the changes of left ventricular geometric pattern in hypertension

作　　者：朱韵 葛志祥 张春旭 杨珍妮 王幸[1] 刘飞[2] 徐敏[2] 杨玲[4] ZHU Yun;GE Zhi-xiang;Zhang Chun-xu;Yang Zhen-ni;Wang Xing;Liu Fei;Xu Min;Yang Ling(Department of Electrocardiogram,Changzhou First People's Hospital Affiliated to Soochow University,Changzhou,Jiangsu 213003;Department of Echocardiogram,Changzhou First People's Hospital Affiliated to Soochow University,Changzhou,Jiangsu 213003;Department of Cardiology,Changzhou Traditional Chinese Medicine Hospital,China;Cardiology of Changzhou First Peoples Hospital Affiliated to Soochoxv University Internal Medicine,China)

机构地区：[1]苏州大学附属常州市第一人民医院心电图室,江苏常州213003 [2]苏州大学附属常州市第一人民医院心超室,江苏常州213003 [3]常州市中医院心内科 [4]苏州大学附属常州市第一人民医院心内科

出　　处：《中华高血压杂志》2021年第4期343-348,共6页Chinese Journal of Hypertension

基　　金：国家自然科学基金面上项目(81871381);国家自然科学青年基金项目(81701734);常州市科技局应用基础研究(CJ20190086);常州市卫计委指导项目(WZ201804)。

摘　　要：目的测试改良的Cornell标准诊断原发性高血压(EH)左心室构型改变的价值。方法选取常州市第一人民医院、常州市中医院诊断的EH患者381例,采用福田FX7402心电综合自动分析仪进行心电图检查,改良的Cornell标准定义为R_(aVL)+S_(D)(十二导联心电图中最深S波)。用超声心动图测量左心室质量并计算左心室质量指数(LVMI),根据美国超声心动图学会对左心室构型的分组标准将患者分为正常构型(n=109)、向心性重构(n=102)、向心性肥厚(n=111)和离心性肥厚组(n=59)。按性别分层,采用趋势性检验评估改良的Cornell标准诊断EH患者左心室异常构型的价值,并与Cornell(SV3+R_(aVL))和Sokolow-Lyon标准(SV1+RV5或RV6)进行比较。结果男性和女性中,改良的Cornell标准在左心室正常构型、向心性重构、向心性肥厚和离心性肥厚组间比较,差异有统计学意义[男性中分别为(1.35±0.66)比(1.59±0.75)比(2.11±0.51)比(2.49±0.96)mV,F=25.064,P<0.001;女性中分别为(1.15±0.40)比(1.52±0.66)比(1.85±0.72)比(1.52±0.78)mV,F=9.392,P<0.001]。相关性分析显示,改良的Cornell标准与LVMI呈正相关(r=0.577,P<0.001)。在男性、女性高血压患者中,随着左心室构型改变的加重(正常构型→向心性构型→向心性肥厚→离心性肥厚),改良Cornell标准电压值呈增加趋势(均P<0.01),而在女性患者中,Cornell标准和Sokolow-Lyon标准的电压值随构型改变增加的趋势无统计学意义。结论改良的Cornell标准与EH患者的左心室构型改变的严重程度相关。Objective To investigate the value of improved Cornell criteria in evaluating the changes of left ventricular geometry in patients with essential hypertension(EH).Methods A total of 381 EH patients in Changzhou First People’s Hospital and Changzhou Traditional Chinese Medicine Hospital were enrolled.Electrocardiogram(ECG)examination was performed with Futian FX7402 automatic analyzer.The improved Cornell criterion was defined as R_(aVL)+S_(D)(the deepest S wave in 12 lead ECG).The left ventricular mass was measured by echocardiography and the left ventricular mass index(LVMI)was calculated.The patients were divided into four groups:normal geometry(n=109),concentric remodeling(n=102),concentric hypertrophy(n=111)and eccentric hypertrophy group(n=59)according to the criteria of American Society of Echocardiography.Stratified by gender,the value of the improved Cornell criteria in diagnosing abnormal left ventricular geometric pattern was evaluated in EH patients using trend test,and compared with Cornell(SV3+R_(aVL))and Sokolow-Lyon criteria(SV1+RV5 or RV6).Results There were statistically significant differences in Cornell’s criteria among normal geometry,concentric remodeling,concentric hypertrophy and eccentric hypertrophy groups in male[(1.35±0.66)vs(1.59±0.75)vs(2.11±0.51)vs(2.49±0.96)mV,F=25.064,P<0.001]and female[(1.15±0.40)vs(1.52±0.66)vs(1.85±0.72)vs(1.52±0.78)mV,F=9.392,P<0.001].Correlation analysis showed that the improved Cornell criteria was positively correlated with LVMI(r=0.577,P<0.001).In the males and females,the adjusted median voltage values of improved Cornell criteria showed an increasing trend with the aggravation of the configuration change of EH(normal configuration,centripetal configuration,centripetal hypertrophy,eccentric hypertrophy;all P<0.01),whiles there was no such trend for Cornell and Sokolow-Lyon criteria in females.Conclusion The improved Cornell criteria is associated with the severity of left ventricular geometric changes in EH patients.

关 键 词：原发性高血压 左心室肥厚 心室构型 心电图 改良Cornell标准 

分 类 号：R544.1[医药卫生—心血管疾病]