心肌淀粉样变患者诊断中心电图联合超声心动图的临床分析  

Clinical Analysis of Electrocardiogram Combined with Echocardiography in Diagnosis of Myocardial Amyloidosis

作　　者：张廷训 马运伟[1] 马运祥[2] ZHANG Tingxun;MA Yunwei;MA Yunxiang(Department of Functional Inspection,Tengzhou Central People's Hospital of Shandong Province,Tengzhou,Shandong Province,277500 China;Department of Cardiovascular Internal Medicine,Tengzhou Central People's Hospital of Shandong Province,Tengzhou,Shandong Province,277500 China)

机构地区：[1]山东省滕州市中心人民医院功能检查科,山东滕州277500 [2]山东省滕州市中心人民医院心血管内科,山东滕州277500

出　　处：《系统医学》2021年第14期20-24,共5页Systems Medicine

基　　金：DPP4抑制剂阿纳格列汀对缺氧诱导的心脏H9C2细胞毒性的保护作用(JYFC2019FKJ018)。

摘　　要：目的探究对心肌淀粉样变(CA)患者诊断中应用心电图+超声心动图临床应用价值。方法选该院2018年1月—2020年7月期间78例CA患者及同期78名健康体检者为研究对象,分为设为患者组、对照组,均实施心电图及超声心动图检查,分析以上两种检查方式联合应用价值。结果①心电图检查:患者组心房颤动、肢导联低电压、假性梗死波形、R波进展不良占比均较对照组高;Ⅰ导联、aVR导联、aVF导联、V5导联、V6导联QRS波群绝对值均较对照组低,差异有统计学意义(P<0.05);aVL导联QRS水平与对照组相近,差异无统计学意义(t=1.696,P>0.05);②超声心动图检查:患者组LVEDD、LVEF水平较对照组低,LA、LVPW、IVS水平较对照组高,差异有统计学意义(t=4.456、17.037、8.189、12.889、13.998,P<0.05);③心电图+超声心动图检查:患者组RⅠ/LVPW、RV5/LVPW、RV6/LVPW、RaVL/LVPW、RⅠ/IVS、RaVL/IVS水平均较对照组低,差异有统计学意义(t=27.928、24.505、20.599、10.177、17.730、7.949,P<0.05);④ROC曲线分析:RⅠ/LVPW曲线下面积最大,RⅠ/LVPW<0.36时CA诊断敏感度97.44%、特异度为95.15%。结论在CA诊断中,应用心电图+超声心动图诊断效果理想,其中RⅠ/LVPW诊断敏感性更为理想。Objective To explore the clinical application value of electrocardiogram + echocardiography in the diagnosis of myocardial amyloidosis(CA) patients. Methods 78 patients with CA from January 2018 to July 2020 in the hospital, and 78 healthy subjects in the same period were selected as the research objects. They were divided into patient group and control group. Both ECG and echocardiogram examinations were performed, and the above analysis was performed. The combined application value of the two inspection methods. Results 1.ECG examination: the proportions of atrial fibrillation, low voltage in limb leads, pseudo-infarction waveform, and poor R wave progression in the patient group were higher than those in the control group;lead Ⅰ, a VR, aVF, V5, V6 absolute values of QRS complexes in leads were lower than those in the control group,the difference was statistically significant(P<0.05);the QRS level in lead aVL was similar to that of the control group(t=1.696, P>0.05);2.Echocardiographic examination: the levels of LVEDD and LVEF in the patient group were lower than those in the control group, and the levels of LA,LVPW, and IVS were higher than those in the control group,the difference was statistically significant(t=4.456, 17.037,8.189, 12.889, 13.998, P<0.05);3.ECG + echocardiography inspection: the levels of RⅠ/LVPW, RV5/LVPW, RV6/LVPW,Ra VL/LVPW, RⅠ/IVS, RaVL/IVS in the patient group were lower than those in the control group,the difference was statistically significant(t =27.928, 24.505, 20.599, 10.177, 17.730, 7.949, P <0.05);4.ROC curve analysis: the area under the RⅠ/LVPW curve was the largest. When RⅠ/LVPW <0.36, the diagnostic sensitivity of CA was97.44% and the specificity was 95.15%. Conclusion In the diagnosis of CA, the diagnostic effect of electrocardiogram + echocardiography is ideal, and the diagnostic sensitivity of RⅠ/LVPW is more ideal.

关 键 词：心肌淀粉样变(CA) 心电图 超声心动图 

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