P波离散度及P波最大时限诊断阵发性心房颤动的价值  

Values of P-wave dispersion and maximum P-wave duration to the diagnosis of paroxysmal atrial fibrillation

作　　者：杜娟 徐金义 王庆义 杨丽红 DU Juan;XU Jin-yi;WANG Qing-yi;YANG Li-hong(The Second Clinics,Henan Provincial Government Organizations,Zhengzhou,Henan 450003,China;Department of Heart and Lung Functional Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省直属机关第二门诊部,河南郑州450003 [2]河南省人民医院心肺功能科郑州大学人民医院,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2022年第3期292-294,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省高等学校重点科研项目计划(18A320053)。

摘　　要：目的观察阵发性心房颤动(paroxysmal atrial fibrillation, PAF)患者P波离散度(P-wave dispersion, Pd)、P波最大时限(maximum P-wave duration, Pmax)变化,探讨其在PAF诊断中的价值。方法 PAF患者120例为PAF组,同期120例体检者为对照组。记录2组性别,年龄,体质量指数,吸烟、冠心病、高血压病、糖尿病比率,血清三酰甘油、低密度脂蛋白胆固醇水平及左心房内径、左室射血分数;行心电图检查,记录Pmax和P波最小时限(minimum P-wave duration, Pmin),计算Pd;绘制ROC曲线,评估Pd、Pmax单独及联合诊断PAF的价值。结果 PAF组年龄,体质量指数,左心房内径,左室射血分数,血清三酰甘油、低密度脂蛋白胆固醇水平及男性、吸烟、冠心病、高血压病、糖尿病比率与对照组比较差异均无统计学意义(P>0.05)。PAF组Pd[(47.76±8.52)ms]、Pmax[(122.36±10.28)ms]均长于对照组[(23.51±5.18)、(102.15±8.36)ms](t=26.642,P<0.001;t=16.708,P<0.001),Pmin[(75.83±18.26)ms]与对照组[(76.37±19.28)ms]比较差异无统计学意义(t=0.223,P=0.824)。Pd、Pmax分别以40 ms、110 ms为最佳截断值,诊断PAF的AUC分别为0.991(95%CI:0.984~0.999,P<0.001)、0.941(95%CI:0.914~0.968,P<0.001),灵敏度分别为94.2%、83.3%,特异度分别为96.7%、90.0%;Pd和Pmax联合诊断PAF的AUC为0.999(95%CI:0.997~1.000,P<0.001),灵敏度为99.2%,特异度为98.3%。结论 PAF患者Pd、Pmax增大,二者联合诊断PAF有较高价值。Objective To observe the changes of P-wave dispersion(Pd) and maximum P-wave duration(Pmax) in patients with paroxysmal atrial fibrillation(PAF), and to explore their values to the diagnosis of PAF. Methods Totally 120 PAF patients(PAF group) and 120 healthy volunteers(control group) were recorded the gender, age, body mass index, percentages of patients with smoking history, coronary heart disease, hypertension and diabetes, levels of serum triacylglycerol and low-density lipoprotein cholesterol(LDL-C), left atrial diameter, and left ventricular injection fraction. Pmax and minimum P-wave duration(Pmin) were measured on electrocardiogram, and Pd was calculated. ROC curve was drawn to evaluate the values of single and combined detection of Pd and Pmax to the diagnosis of PAF. Results There were no significant differences in the age, body mass index, left atrial diameter, left ventricular injection fraction, serum triacylglycerol, LDL-C, and the percentages of male patients and patients with smoking history, coronary heart disease, hypertension and diabetes between two groups(P>0.05). Pd and Pmax were longer in PAF group [(47.76±8.52),(122.36±10.28) ms] that those in control group [(23.51±5.18),(102.15±8.36) ms](t=26.642, P<0.001;t=16.708, P<0.001), and Pmin showed no significant difference between two groups [(75.83±18.26) ms vs.(76.37±19.28) ms](t=0.223,P=0.824). When the optimal cut-off values of Pd and Pmax were 40 ms and 110 ms, the AUCs of single and combined detection of Pd and Pmax for diagnosing PAF were 0.991(95%CI: 0.984-0.999, P<0.001), 0.941(95%CI: 0.914-0.968, P<0.001) and 0.999(95%CI: 0.997-1.000, P<0.001), the sensitivities were 94.2%, 83.3% and 99.2%, and the specificities were 96.7%, 90.0% and 98.3%, respectively. Conclusion Pd and Pmax increase in patients with PAF, and the combined detection of them two is of great value to the diagnosis of PAF.

关 键 词：阵发性心房颤动 P波离散度 P波最大时限 心电图 

分 类 号：R541.75[医药卫生—心血管疾病]