合并完全性左束支阻滞的急性心肌梗死心电图诊断效度的回顾性队列研究  

A retrospective cohort study on electrocardiogram diagnostic efficiency of acute myocardial infarction in patients with complete left bundle branch block

作　　者：仲涛[1] 韩汶君 陈岩 付基伟 方燕飞 张培训[2] 郭继鸿[2] Zhong Tao;Han Wenjun;Chen Yan;Fu Jiwei;Fang Yanfei;Zhang Peixun;Guo Jihong(Department ofElectrocardiography,Weifang People's Hospital,Weifang,261041,China;Department ofCardiology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]潍坊市人民医院心电图室,261041 [2]北京大学人民医院心内科,100044

出　　处：《中国心血管杂志》2021年第6期520-524,共5页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金(31771322)。

摘　　要：目的探讨巴塞罗那标准和改良的Sgarbossa标准在心电图诊断合并完全性左束支阻滞(CLBBB)的急性心肌梗死(AMI)过程中心电图各导联的特征表现,分析其诊断效能。方法回顾性分析北京大学人民医院和山东潍坊市人民医院的临床病例,纳入心电图诊断CLBBB的患者资料。经过心肌酶学检查和冠状动脉造影临床确诊为AMI的CLBBB患者84例作为试验组,未诊断AMI的CLBBB患者83例作为对照组,用巴塞罗那标准和改良的Sgarbossa标准分析入院后第一份心电图。研究分析试验组和对照组心电图各导联的特征性表现,对比巴塞罗那标准和改良的Sgarbossa标准的诊断敏感度和准确度。采用受试者工作特征(ROC)曲线及曲线下面积(AUC)比较两种方法的诊断准确性。结果与改良的Sgarbossa标准比较,巴塞罗那标准的敏感度(92.9%比63.1%)、阴性预测值(92.3%比71.2%)和准确度(89.8%比77.8%)均明显更高(均为P<0.01),但两组的特异度(86.7%比92.8%)和阳性预测值(87.6%比89.8%)比较差异均无统计学意义(均为P>0.05)。ROC曲线显示,巴塞罗那标准的AUC显著高于改良的Sgarbossa标准(P<0.01)。结论心电图巴塞罗那标准诊断合并CLBBB的AMI的敏感度优于改良的Sgarbossa标准,但两种方法的诊断特异性相似。Objective To investigate the characteristics of ECG leads by Barcelona algorithm and modified Sgarbossa criteria in the diagnosis of acute myocardial infarction(AMI)in patients with complete left bundle branch block(CLBBB),and to analyze their diagnostic efficacy.Methods Clinical cases from Peking University People's Hospital and Shandong Weifang People's Hospital were retrospectively analyzed,and their electrocardiogram data diagnosed with CLBBB.Among them,84 cases of CLBBB with AMI,which were clinically confirmed by myocardial enzymology examination and coronary angiography,were selected as the experimental group;83 CLBBB patients without AMI served as the control group.The first electrocardiogram after admission was analyzed by Barcelona algorithm and modified Sgarbossa criteria.We analyzed the characteristics of each lead in the electrocardiogram of all patients and compared the diagnostic sensitivity and accuracy of Barcelona algorithm and modified Sgarbossa criteria using the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results Compared with the modified Sgarbossa criteria,the Barcelona algorithm's sensitivity(92.9%vs.63.1%),negative predictive value(92.3%vs.71.2%)and accuracy(89.8%vs.77.8%)in the diagnose of CLBBB with AMI were significantly higher(all P<0.01).However,the specificity(86.7%vs.92.8%)and positive predictive value(87.6%vs.89.8%)were similar between the two groups(both P>0.05).In addition,the ROC curve showed that Barcelona algorithm was associated with higher AUC than the modified Sgarbossa criteria(P<0.01).Conclusions Barcelona algorithm is more sensitive than modified Sgarbossa criteria for the diagnose of CLBBB with AMI,but the specificities were similar between groups.

关 键 词：完全性左束支阻滞 急性心肌梗死 心电图 

分 类 号：R542.22[医药卫生—心血管疾病]