心电图Tp-Te间期对肺栓塞的诊断价值  

Diagnostic value of Tp-Te interval in pulmonary embolism

作　　者：黄蕾[1] 宋艳丽[1] 吴先正[1] 孙跃喜[1] 郭刚[1] 杨晓峰[1] HUANG Lei;SONG Yan-li;WU Xian-zheng;SUN Yue-xi;GUO Gang;YANG Xiao-feng(Dept.of Emergency,Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院急诊医学科,上海200065

出　　处：《同济大学学报（医学版）》2021年第3期354-360,共7页Journal of Tongji University(Medical Science)

基　　金：上海市科学技术委员会中医引导项目(19401930700);上海市卫生健康委员会急诊与危重症重要薄弱学科项目(2016ZB0204)。

摘　　要：目的探讨心电图T波峰末间期(Tpeak-tend interval,Tp-Te)在急性肺栓塞中的诊断价值。方法采用前瞻性队列研究,入选2017年1月—2019年3月于同济大学附属同济医院急诊科就诊的可疑肺栓塞患者共142例。根据CT肺动脉血管成像(CT pulmonary angiography,CTPA)结果分为肺栓塞组与对照组。收集所有入组患者详细临床资料,于入院1 h内进行Wells评分、Geneva评分,完成12导联心电图检查,完成D-Dimer、TnI和BNP检测。测量心电图一般指标以及各胸导联QRS波时间、QT间期及Tp-Te间期,计算Daniel心电图评分。建立受试者工作特征曲线(characteristic curve,ROC)评价Tp-Te间期、各肺栓塞评分及其联合对肺栓塞的预测价值,多变量逻辑回归模型评价预测肺栓塞的独立危险因素。结果研究共收集142例患者,其中肺栓塞组63例,对照组79例,两组间年龄、性别差异无统计学意义。与对照组比较,肺栓塞组的Wells评分和修正的Geneva评分明显升高(P<0.05);肺栓塞组V2,V3,V4,V5及V6导联Tp-Te间期均明显升高(P<0.05);ROC曲线显示各Tp-Te间期对肺栓塞患者诊断价值最高的为V5导联Tp-Te间期,其曲线下面积(aera under the curve,AUC)、灵敏度、特异度分别为0.636、0.508、0.709,诊断界值为85 ms;V1~V6导联Tp-Te间期联合诊断的AUC、灵敏度、特异度分别为0.711、0.590、0.744。Tp-Te间期联合修正的Geneva评分对肺栓塞患者诊断的AUC、灵敏度、特异度分别为0.770,0.645、0.833。Logistic回归分析结果发现下肢水肿、平均动脉压、Wells评分、修正的Geneva评分、V2~V6导联Tp-Te间期为预测肺栓塞的独立预测因子(P<0.05)。结论心电图V2~V6导联Tp-Te间期对肺栓塞有一定诊断价值,Tp-Te间联合肺栓塞评分、D-Dimer可用于肺栓塞的早期诊断。Objective To investigate the diagnostic value of Tpeak-Tend interval(Tp-Te)in acute pulmonary embolism.Methods In a prospective cohort study,142 patients with suspected pulmonary embolism were admitted to the emergency department of Tongji Hospital affiliated to Tongji University from January 2017 to March 2019.They were divided into pulmonary embolism group and the control group according to the CTPA results.The detailed clinical data of enrolled patients were collected,the Wells score and Geneva score were assessed within 1 hour after admission,and the 12-lead ECG examination was completed,the serum levels of D-Dimer,TnI and BNP were determined.The QRS wave time,QT interval and Tp-Te interval of thoracic lead,the general ECG indicators and the Daniel score were measured.The receiver operating characteristic curve(ROC)was established to evaluate the predictive value of Tp-Te interval,pulmonary embolism scores and the combination of the two.Multivariate logistic regression model was used to analyze the independent risk factors for predicting pulmonary embolism.Results A total of 142 patients were enrolled,including 63 in the pulmonary embolism group and 79 in the control group.There was no significant difference in age and gender between the two groups.Compared with the control group,the Wells score and the modified Geneva score were both significantly elevated in the pulmonary embolism group(P<0.05);the Tp-Te intervals of V2,V3,V4,V5 and V6 leads were all significantly increased in the pulmonary embolism group(P<0.05).ROC curve showed that the Tp-Te interval of V5 lead had highest diagnostic value in patients with pulmonary embolism;the area under the curve(AUC)was 0.636,the sensitivity and specificity were 0.508 and 0.709 with the cut-off value of 85ms.The AUC,sensitivity and specificity of the combined Tp-Te interphase of V1 V6 lead were 0.711,0.590 and 0.744,respectively.The AUC,sensitivity,and specificity of the Tp-Te interim combined with Geneva score for the diagnosis of pulmonary embolism were 0.770,0.645

关 键 词：肺栓塞 心电图 TP-TE间期 诊断价值 

分 类 号：R563.5[医药卫生—呼吸系统]