常规心电图在高血压患者不同构型左心室肥厚诊断中的应用价值  

Application value of routine electrocardiogram in the diagnosis of left ventricular hypertrophy with different configurations in patients with hypertension

作　　者：杨帆 李昕昊 李萌萌 盛媛媛 徐铭俊[1] 张瑜[1] 张澄[1] 张运[1] 张梅[1] Yang Fan;Li Xin-Hao;Li Meng-Meng;Sheng Yuan-Yuan;Xu Ming-Jun;Zhang Yu;Zhang Cheng;Zhang Yun;Zhang Mei(Department of Cardiology,Qilu Hospital/the First Clinical College of Shandong University,Jinan,Shandong 250012,China)

机构地区：[1]山东大学齐鲁医院/山东大学第一临床学院心内科,山东济南250012

出　　处：《解放军医学杂志》2023年第1期71-77,共7页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(82001834)。

摘　　要：目的分析常规心电图在高血压患者不同构型左心室肥厚(LVH)诊断中的应用价值。方法收集2016年9月-2021年3月于山东大学齐鲁医院就诊的228例原发性高血压患者的临床资料,回顾性分析其超声心动图及心电图结果。按照2018欧洲心脏病学会(ESC)/欧洲高血压学会(ESH)标准进行左心室Ganau分型划分,将患者分成正常构型(NG)组(n=58)、向心型重构组(CR)组(n=107)、离心型肥厚(EH)组(n=24)、向心型肥厚(CH)组(n=39);所有患者再按照中国汉族正常成年人超声心动图测量值研究(EMINCA)标准分为NG组(n=105)、CR组(n=27)、EH组(n=81)、CH组(n=15)。比较按照不同标准划分左心室构型结果的一致性,并分析心电图对不同左心室构型的诊断价值及组间差异。结果按照2018 ESC/ESH标准和EMINCA标准对左心室构型类型的划分结果存在明显差异(P<0.01),一致性较差(Kappa=0.330,P<0.01)。按照2018 ESC/ESH标准分型,心电图诊断LVH在NG、CR、EH、CH各组中的阳性率分别为5.2%、7.5%、29.2%、30.8%,组间差异有统计学意义(P<0.01),且EH组或CH组的阳性率明显高于NG组或CR组(P<0.0083)。心电图诊断LVH的敏感度为30.2%,特异度为93.3%。按照中国EMINCA标准分型,心电图诊断LVH在NG组、CR组、EH组、CH组的阳性率分别为1.9%、3.7%、25.9%、40.0%,组间差异有统计学意义(P<0.01),且EH组、CH组的阳性率均明显高于NG组(P<0.0083),心电图诊断LVH的敏感度为28.1%,特异度为97.7%。结论2018 ESC/ESH标准和EMINCA标准对左心室构型的划分存在明显差异。心电图在两种不同标准中对LVH的诊断敏感度低,特异度较高。Objective To explore the application value of routine electrocardiogram in the diagnosis of left ventricular hypertrophy(LVH)in hypertensive patients using different configuration diagnostic criteria.Methods The clinical data were collected of 228 patients with essential hypertension treated in Qilu Hospital of Shandong University from September 2016 to March 2021,and the results of echocardiography and electrocardiogram were retrospectively analyzed.Ganau classification of left ventricle was done according to 2018 European Society of Cardiology(ESC)/European Society of Hypertension(ESH)criteria.The patients were divided into normal configuration(NG,n=58)group,concentric remodeling(CR,n=107)group,eccentric hypertrophy(EH,n=24)group and concentric hypertrophy(CH,n=39)group.The classification was done again according to the Echocardiographic Measurements in Normal Chinese Adults(EMINCA)criteria,patients were divided into NG group(n=105),CR group(n=27),EH group(n=81)and CH group(n=15).The consistency of the results of left ventricular configuration classification according to different criteria was compared,and the diagnostic value of ECG in different left ventricular configuration and the difference between groups were analyzed.Results The results of configuration classified according to the 2018 ESC/ESH criteria and EMINCA criteria had statistical difference(P<0.01),and the consistency was poor(Kappa=0.330,P<0.01).According to the 2018ESC/ESH criteria,the positive rate of ECG in NG group,CR group,EH group and CH group were 5.2%,7.5%,29.2%,and 30.8%,respectively.The differences among groups were statistically significant(P<0.01).The positive rate of EH group or CH group was significantly higher than that in NG group or CR group(P<0.0083).The sensitivity and specificity of ECG in diagnosing LVH were 30.2%and 93.3%,respectively.According to the EMINCA criteria,the positive rate of ECG in diagnosing LVH in NG group,CR group,EH group and CH group were 1.9%,3.7%,25.9%,and 40.0%respectively.The differences among groups w

关 键 词：高血压 左心室构型 心电图 超声心动图 

分 类 号：R544.1[医药卫生—心血管疾病]