量化指标在心房颤动伴宽QRS波鉴别中的临床价值分析  

Clinical value analysis of quantitative indexes in the differentiation of atrial fibrillation with wide QRS waves

作　　者：徐建昌 来欣[1] 饶盼盼[1] 罗俊苗 陈葵[1] 王晞[1] Xu Jianchang;Lai Xin;Rao Panpan;Luo Junmiao;Chen Kui;Wang Xi(Department of Cardiology,Renmin Hospital of Wuhan University,Hubei Province,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院心内科/武汉大学心血管病研究所/心血管病湖北省重点实验室,430060

出　　处：《疑难病杂志》2023年第3期225-230,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：国家自然科学基金资助项目(81772044)。

摘　　要：目的 分析与宽QRS波相关的量化指标(前间期/联律间期、类代偿间期/前间期、类代偿间期/联律间期)在心房颤动(房颤)伴宽QRS波(房颤伴室性早搏和室内差传)鉴别中的临床价值。方法 选择2020年1月—2022年6月武汉大学人民医院心内科阵发性房颤患者113例的动态心电图,其中房颤伴室性早搏80例(房早组),房颤伴室内差异性传导33例(房差组),比较2组传统鉴别指标的分布特征、量化指标,绘制ROC曲线评估量化指标对房颤伴宽QRS波鉴别的临床价值。结果 2组患者性别、年龄、吸烟史、饮酒史、高血压、冠心病、糖尿病比较,差异无统计学意义(P>0.05),房早组心力衰竭患病率高于房差组(χ^(2)/P=3.935/0.047);在传统鉴别指标中,房早组蝉联现象、QRS波时限≤140 ms、V1导联QRS形态3相波比例低于房差组,V1导联R波或者qR或者R大于r或者rS最深处大于60 ms、aVR导联QRS波起始有顿挫或者下降比较慢或者呈大R、aVR导联Vi/Vt≤1、无人区电轴比例显著高于房差组(χ^(2)/P=15.061/<0.001,48.035/<0.001,29.697/<0.001,31.926/<0.001,61.464/<0.001,45.286/<0.001,4.034/0.045)。在量化指标中,房早组类代偿间期/联律间期、类代偿间期/前间期比值大于房差组(t/P=9.165/<0.001,29.015/<0.001),而前间期/联律间期比值小于房差组(t/P=18.907/<0.001);ROC曲线显示,前间期/联律间期、类代偿间期/联律间期、类代偿间期/前间期及三者联合鉴别房颤伴宽QRS波的AUC分别0.865、0.688、0.934和0.944,且三者联合预测价值高于单个量化指标(Z/P=7.796/<0.001,12.633/<0.001,3.061/0.002)。结论 量化指标三者联合及类代偿间期/前间期具有较好的诊断价值,可为房颤伴室早和室内差传的鉴别提供重要参考。Objective To analyze the clinical value of quantitative indicators related to wide QRS wave(pre/synrhythmic interval, quasi compensatory interval/pre interval, quasi compensatory interval/synrhythmic interval) in the differentiation of atrial fibrillation(AF) with wide QRS wave(AF with ventricular premature beats and ventricular differential transmission).Methods From January 2020 to June 2022, 113 patients with paroxysmal atrial fibrillation in the Department of Cardiology, People’s Hospital of Wuhan University were selected for dynamic electrocardiogram, including 80 patients with atrial fibrillation and ventricular premature beats(atrial premature group) and 33 patients with atrial fibrillation and ventricular differential transmission(atrial differential group). The distribution characteristics and quantitative indicators of the two groups of traditional identification indicators were compared, and the ROC curve was drawn to evaluate the clinical value of quantitative indicators in the identification of atrial fibrillation and wide QRS wave.Results There was no significant difference between the two groups in terms of gender, age, smoking history, drinking history, hypertension, coronary heart disease and diabetes(P>0.05). The prevalence of heart failure in the atrial premature beats group was higher than that in the atrial arrhythmias group(χ^(2)/P=3.935/0.047).In the traditional identification indicators, the association phenomenon of the atrial premature group, the QRS wave duration ≤ 140 ms, the proportion of the phase 3 wave of the V1 lead QRS form is lower than that of the atrial poor group, the R wave or qR or R of the V1 lead is greater than r, or the deepest rS is greater than 60 ms, the QRS wave of the aVR lead has a sudden setback or a slow decline or a large R, the aVR lead Vi/Vt ≥ 1, and the proportion of the electric axis in the unmanned area is higher than that of the atrial poor group(χ^(2)/P=15.061/<0.001,48.035/<0.001,29.697/<0.001,31.926/<0.001,61.464/<0.001,45.286/<0.001,4.034/0.04

关 键 词：心房颤动 室性早搏 宽QRS波 室内差异性传导 量化指标 

分 类 号：R541.7[医药卫生—心血管疾病]