心电图心室复极化指标对阻塞性睡眠呼吸暂停低通气综合征患者夜间室性早搏的预测价值  

Predictive Value of Ventricular Repolarization Index of Electrocardiogram in Nocturnal Premature Ventricular Contractions in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

作　　者：黄兵[1] 闫慧[2] 周纪宁[1] 幸世峰[2] 龙庆红[3] Huang Bing;Yan Hui;Zhou Jining(Department of Card iovascular Medicine,People's Hospital of Wuhan University,Wuhan 430060,China;Department of Cardiovascular Medicine,the Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]武汉大学人民医院心血管内科,武汉430060 [2]新疆医科大学第五附属医院心血管内科,乌鲁木齐830011 [3]武汉大学人民医院门诊办公室,武汉430060

出　　处：《华中科技大学学报（医学版）》2023年第4期535-539,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省自然科学基金资助项目(No.2021CFB440,No.2021CFB334)。

摘　　要：目的探索阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并夜间频发室性早博(PVC)患者心电图心室复极化指标的变化及其预测价值。方法回顾性分析首次确诊为OSAHS并未行治疗的患者509例,根据动态心电图结果,符合夜间频发PVC的患者纳入OSAHS+PVC组(45例),匹配同期初诊为OSAHS且无心律失常的患者(45例)为OSAHS组。分析患者的一般病历资料和心电图中的Tp-e间期、Tp-e与QT的比值(Tp-e/QT)、校正QT间期(QTc)、Tp-e与QTc的比值(Tp-e/QTc)和QT间期离散度(QTd)等指标。结果OSAHS+PVC组患者的Tp-e、Tp-e/QT、Tp-e/QTc、QTd明显高于OSAHS组(均P<0.05)。单因素回归分析发现Tp-e、Tp-e/QT、Tp-e/QTc、QTd是OSAHS患者夜间发生PVC的危险因素。多因素回归分析和ROC曲线分析发现,Tp-e/QT升高和QTd延长与OSAHS患者夜间频发PVC的相关性最强(均P<0.01),Tp-e/QT的曲线下面积最大(0.901)。结论代表心室复极化异常的心电图指标,包括Tp-e、Tp-e/QT、Tp-e/QTc、QTd在OSAHS相关夜间频发PVC患者中显著升高。Tp-e/QT升高和QTd延长是OSAHS相关夜间频发PVC的重要危险因素,而Tp-e/QT延长对OSAHS相关夜间频发PVC有较好的预测价值。Objective To explore the changes of ventricular repolarization index and its predictive value in patients with ob-structive sleep apnea hypopnea syndrome(OSAHS)complicated with frequent nocturnal remature ventricular contractions(PVC).Methods Patients diagnosed with OSAHS for the first time without treatment were retrospectively analyzed(509 ca-ses).According to the results of ambulatory electrocardiogram,patients with frequent PVC at night were included in the OS-AHS+PVC group(n-45),and patients with OSAHS and no arrhythmias were matched with the OSAHS group(n=45).The.general medical records of patients and the indicators of Tp-e interval,ratio of Tpre to QT(Tpre/QT),corrected QT interval(QTc),ratio of Tp-e to QTe(Tp-e/QTc)and QT interval dispersion(QTd)in the ECG were analyzed.Results Tp-e,Tp-e/QT,Tp-e/QTc and QTd in OSAHS+PVC group were significantly higher than those patients in OSAHS group(P<0.05).Univa-riate regression analysis found that Tpre,Tp-e/QT,Tp-e/QTc and QTd were the risk factors of nocturnal frequent PVC.Multivariate regression analysis and ROC curve analysis found that the prolonged Tp-e/QT and QTd had the strongest correlation with nocturnal frequent PVC in OSAHS patients(P<0.01),and the area under the curve of Tpre/QT was the lar-gest 0.901(0.834-0.968).Conclusion ECG indexes representing abnormal ventricular repolarization,including Tpre,Tp-e/QT,Tp-e/QTc,and QTd,were significantly elevated in patients with OSAHS related nocturnal frequent PVC.Prolonged Tp-e/QT and QTd are significant risk factors of OSAHS related nocturnal PVC,and prolonged Tp-e/QT has a good predictive value for OSAHS related nocturnal frequent PVC.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 室性早搏 心电图 Tp-e Tp-e/QT QTD 

分 类 号：R541.7[医药卫生—心血管疾病]