动态心电图P波离散度和Tp-e间期联合血压变异性对原发性高血压患者室性心律失常易感性的预测效能  

Predictive efficacy of ambulatory electrocardiogram P-wave dispersion and Tp-e interval combined blood pressure variability on susceptibility to ventricular arrhythmias in patients with essential hypertension

作　　者：郑莉凡 张振玉 王秀芹[2] ZHENG Li-fan;ZHANG Zhen-yu;WANG Xiu-qin(Cardio-eeg room,Tai’an Maternal and Child Health Hospital,Tai’an 271000,China;Department of cardiology,Tai’an Maternal and Child Health Hospital,Tai’an 271000,China)

机构地区：[1]泰安市妇幼保健院心脑电图室,山东省泰安市271000 [2]泰安市妇幼保健院心内科,山东省泰安市271000

出　　处：《中国心血管病研究》2023年第6期538-543,共6页Chinese Journal of Cardiovascular Research

基　　金：山东省医药卫生科技发展计划项目(202204071017)。

摘　　要：目的 观察原发性高血压患者室性心律失常易感性状况,并分析动态心电图P波离散度、T波峰-末(Tp-e)间期联合血压变异性对其预测效能。方法 纳入2020年6月至2022年6月医院126例原发性高血压患者为研究对象。入院时所有患者均接受动态心电图检查与血压变异性检查,记录P波离散度、Tp-e间期值,观察患者室性心律失常发生状况,并将其分为室性心律失常组与非室性心律失常组,分析动态心电图P波离散度、Tp-e间期联合血压变异性对原发性高血压患者室性心律失常易感性的预测效能。结果 126例原发性高血压患者中发生室性心律失常39例,占30.95%;室性心律失常组右心房横径(RAD)[(47.39±6.25)mm]长于非室性心律失常组[(40.37±6.74)mm],P波离散度[(42.82±8.14)ms]、Tp-e间期[(112.96±11.34)ms]、24 h舒张压标准差(24 h diastolic blood pressure standard deviation,24 h DPB-SD)[(13.79±5.22)mmHg]、24 h收缩压标准差(24 h systolic blood pressure standard deviation,24 h SBP-SD)值[(18.75±5.76)ms]高于非室性心律失常组[(36.16±7.28)ms、(99.23±12.61)ms、(9.78±4.36)mmHg、(14.03±5.17)mmHg](P<0.05);经点二列相关性分析显示,动态心电图P波离散度、Tp-e间期、血压变异性(24 h DPB-SD、24 h SBP-SD)值与原发性高血压患者发生室性心律失常呈正相关(r=0.276、0.463、0.207、0.293,P均<0.05);经logistic回归分析,结果显示,高P波离散度、高Tp-e间期、高24 h DPB-SD、高24 h SBP-SD是原发性高血压患者发生室性心律失常的危险因素(OR=1.112、1.095、1.199、1.177,P<0.05);ROC曲线结果显示,P波离散度、Tp-e间期、24 h DPB-SD、24 h SBP-SD预测原发性高血压患者发生室性心律失常的AUC分别为0.733(95%CI 0.635~0.830)、0.800(95%CI 0.723~0.877)、0.719(95%CI 0.621~0.817)、0.712(95%CI 0.614~0.810)、0.912(95%CI 0.863~0.961)。结论 动态心电图P波离散度、Tp-e间期联合血压变异性对原发性高血压患者室性心律失常易感性具Objective To observe the status of ventricular arrhythmia susceptibility in patients with essential hypertension and to analyze the predictive efficacy of dynamic ECG P-wave dispersion and T-wave peak-to-end(Tp-e)interval combined with blood pressure variability.Methods A prospective cohort study of 126 patients with essential hypertension in the hospitals from June 2020 to June 2022 was conducted.All the patients underwent ambulatory electrocardiography and blood pressure variability at admission,and P-wave dispersion and Tp-e interval values were recorded to observe the occurrence of ventricular arrhythmias.The patients were divided into the ventricular arrhythmia and non-ventricular arrhythmia groups.The predictive efficacy of ambulatory electrocardiography P-wave dispersion and Tp-e interval combined with blood pressure variability on the susceptibility to ventricular arrhythmias was analyzed.Results Among 126 patients,39 cases had ventricular arrhythmia,accounting for 30.95%.The Right atrial diameter(RAD)in the ventricular arrhythmia group[(47.39±6.25)mm]was longer than that in non-ventricular arrhythmia group[(40.37±6.74)mm];P wave dispersion[(42.82±8.14)ms],Tp-e interval[(112.96±11.34)ms],24 h diastolic blood pressure standard deviation,24 h DBB-SD[(13.79±5.22)mmHg]and 24 h systolic blood pressure standard deviation(24 h SBP-SD)[(18.75±5.76)ms]were higher than those in the non-ventricular arrhythmia group[(36.16±7.28)ms,(99.23±12.61)ms,(9.78±4.36)mmHg,(14.03±5.17)mmHg](P<0.05).The point-binary correlation analysis showed that the values of P wave dispersion,Tp-e interval and blood pressure variability(24 h DPB-SD,24 h SBP-SD)of dynamic electrocardiogram were positively correlated with ventricular arrhythmia in the patients(r=0.276,0.463,0.207,0.293,P<0.05).Logistic regression analysis showed that high P wave dispersion,high Tp-e interval,high 24 h DPB-SD and high 24 h SBP-SD were the risk factors for ventricular arrhythmia in the patients(OR=1.112,1.095,1.199,1.177,P<0.05).The ROC curve showed th

关 键 词：原发性高血压 室性心律失常 动态心电图 P波离散度 T波峰-末间期 血压变异性 

分 类 号：R541[医药卫生—心血管疾病]