λ波是冠心病患者发生恶性心律失常的新预测因子  

λ wave is a novel predictor of malignant arrhythmias in coronary heart disease

作　　者：郑晓波 樊静静[2] 王广强[3] 仲琳[3] 张东霞[3] 王春筱 荆艳艳[3] 王兰兰 曲军[3] 初红霞[3] ZHENG Xiao-bo;FAN Jing-jing;WANG Guang-qiang;ZHONG Lin;ZHANG Dong-xia;WANG Chun-xiao;JING Yan-yan;WANG Lan-lan;QU Jun;CHU Hong-xia(Department of Cardiology,Weifang Medical University,Weifang 261021,China;Department of Cardiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Cardiology,Yantai Yuhuangding Hospital,Yantai 264000,China)

机构地区：[1]潍坊医学院心内科,山东潍坊261021 [2]华中科技大学同济医学院附属同济医院心内科,湖北武汉430030 [3]烟台毓璜顶医院心内科,山东烟台264000

出　　处：《内科急危重症杂志》2021年第6期462-467,496,共7页Journal of Critical Care In Internal Medicine

基　　金：国家自然科学基金(No:81900310)。

摘　　要：目的:本研究探讨λ波与冠心病(CAD)患者发生恶性心律失常的相关性及可能的机制。方法:收集2018年3月-2020年1月就诊于潍医附院和烟台市毓璜顶医院心血管内科60例CAD患者的临床资料,根据有无λ波分为λ波组(20例)及对照组(40例),对CAD患者行心电图或动态心电图检查,分析λ波形及恶性心律失常发生情况,比较2组之间有无统计学差异。结果:与对照组比较,λ波组晕厥、心律失常及心脏骤停、冠脉痉挛发生率更高(55%vs 7.5%;100%vs 17.5%;40%vs 0%;90%vs 2.5%,P均<0.01)。观察2组心电图分布及形态差异,λ波组中顿挫型J点更常见,λ波主要位于下壁和侧壁导联(90%vs 20%;80%vs 15%,P均<0.01)。λ波组患者严重缓慢心律失常和/或室性心律失常的发生率明显升高(80%vs 10%;85%vs 7.5%,P均<0.01)。结论:λ波常出现在下壁、侧壁导联,可能是预测冠心病患者恶性心律失常发生的一个危险标志。顿挫型J波比平滑型J波更易发生恶性心律失常。λ波形成可能与急性心肌缺血及基因突变有关。Objective:To explore the correlation betweenλwave and malignant arrhythmia in patients with coronary heart disease(CHD)and its possible mechanism.Methods:The data of 60 CAD patients were collected from Affiliated Hospital of Weifang Medical College and Yuhuangding Hospital of Yantai from March 2018 to January 2020.According to the presence ofλwave,the patients were divided intoλwave group(20 cases)and control group(40 cases).Theλwaveform and malignant arrhythmia from electrocardiograms or dynamic electrocardiograms were analyzed,and compared between the two groups.Results:The incidence of syncope,arrhythmia and sudden cardiac arrest,coronary artery spasm was higher in theλwave group than in the control group(55%vs 7.5%;100%vs 17.5%;40%vs 0%;90%vs 2.5%,P<0.01).The distribution and morphological differences of ECG between the two groups were observed.Inλwave group,notched J point was more common(90%vs 20%,P<0.01),andλwave was mainly located in the lower and lateral leads(80%vs 15%,P<0.01).The incidence of severe bradyarrhythmias and/or ventricular arrhythmias was significantly increased in theλwave group(80%vs 10%,P<0.01;85%vs 7.5%,P<0.01).Conclusion:Theλwave often appears in lower wall and lateral wall leads,which may be a risk marker for predicting malignant arrhythmias in patients with CHD.Notched J wave is more likely to cause malignant arrhythmia than smooth J wave.The formation ofλwave may be related to acute myocardial ischemia and gene mutation.

关 键 词：冠心病 心电图 λ波 恶性心律失常 

分 类 号：R541[医药卫生—心血管疾病]