原发性高血压病患者不同左室几何构型的心电图特征  

Electrocardiogram characteristics of different left ventricular geometries in patients with essential hypertension

作　　者：聂文娟 冯应君[1] 叶培机 刘纯钢[1] 黄艳 李泳恩 王婷[1] 谭景[1] 聂思佩 尧素琴 Nie wenjuan;Feng yingjun;Ye peiji;Liu chungang;Huang yan;Li yongen;Wang ting;Tan jing;Nie sipei;Yao suqin(Yue Bei People's Hospital;不详)

机构地区：[1]粤北人民医院,512026 [2]始兴县人民医院,512026

出　　处：《临床心电学杂志》2024年第4期266-270,274,共6页Journal of Clinical Electrocardiology

基　　金：广东省韶关市卫生健康科研项目(项目编号:Y22094)。

摘　　要：目的探讨原发性高血压病患者不同左心室几何构型的心电图特征。方法选取2018至2021年在粤北人民医院住院的100例原发性高血压病患者,使用心脏彩超测定左室舒张末期内径、室间隔厚度和左心室后壁厚度,并计算相对室壁厚度(RWT)、左心室心肌重量指数(LVMI),依据RWT及LVMI分为正常形态组(n=39)、向心性重构组(n=46)、向心性肥厚组(n=12)及离心性肥厚组(n=3)。对各组的心电图特征进行比较,分析LVMI、RWT与心电图参数的相关性。结果(1)向心性肥厚组的R_(Ⅰ)、R_(Ⅱ)、S_(aVR)、R_(aVL)、S_(V1)、S_(V2)、S_(V3)、R_(V5)、R_(V6)高于其余三组,差异具有统计学差异(P<0.05);(2)向心性肥厚组的QRS总振幅、R_(Ⅰ)+S_(Ⅲ)、R_(V5)+S_(V1)、R_(V6)+S_(V1)、R_(V6)+S_(V2)、R_(aVL)+SV_(3)、Cornell指数及SD+SV4均高于其余三组,差异具有统计学意义(P<0.05);(3)R_(Ⅰ)、S_(a VR)、R_(aVL)、S_(V1)、S_(V2)、S_(V3)、R_(V4)、R_(V5)、R_(V6)、R_(Ⅰ)+S_(Ⅲ)、R_(V5)+S_(V1)、R_(V6)+S_(V1)、R_(V6)+S_(V2)、R_(a VL)+SV_(3)、Cornell指数、SD+S_(V4)与LVMI呈正相关。R_(Ⅰ)、R_(Ⅱ)、R_(Ⅲ)、S_(a)V_(R)、R_(a VL)、R_(a VF)、S_(V1)、S_(V2)、S_(V3)、R_(V5)、R_(V6)、R_(Ⅰ)+S_(Ⅲ)、R_(V5)+S_(V1)、R_(V6)+S_(V1)、R_(V6)+S_(V2)、R_(a VL)+S_(V3)、SD+S_(V4)与RWT呈正相关;(4)向心性肥厚组具有ST-T改变的比例高于其余三组(P<0.05)。结论不同左心室几何构型有不同心电图表现,尤其是向心性肥厚患者具有更高的QRS电压及心肌缺血的发生率。Objective To investigate the electrocardiogram characteristics of different left ventricular geometries in patients with essential hypertension.Methods 100 patients with essential hypertension in Yue Bei People's Hospital from 2018 to 2021 were selected.According to RWT and LVMI,they were divided into normal morphology group(39 cases),centripetal remodeling group(46 cases),centripetal hypertrophy group(12 cases),and centrifugal hypertrophy group(3 cases).The electrocardiogram parameters of the four groups were measured,and the differences of each group were compared.LVMI and RWT were performed correlation analysis with electrocardiogram parameters,separately.Results(1)The voltages of R_(Ⅰ),R_(Ⅱ),S_(a VR),R_(a VL),S_(V1),S_(V2),S_(V3),R_(V5),and R_(V6)in the centripetal hypertrophy group were higher than those in the other three groups(P<0.05).(2)The values of∑QRS,R_(Ⅰ)+S_(Ⅲ),R_(V5)+S_(V1),R_(V6)+S_(V1),R_(V6)+S_(V2),R_(a VL)+S_(V3),Cornell index and S_(D))+S_(v4)in the centripetal hypertrophy group were higher than those in the other groups(P<0.05).(3)The values of R_(Ⅰ),S_(a VR),R_(a VL),S_(V1),S_(V2),S_(V3),R_(V4),R_(V5),R_(V6),R_(Ⅰ)+S_(Ⅲ),R_(V5)+S_(V1),R_(V6)+S_(V1),R_(V6)+S_(V2),R_(a VL)+S_(V3),Cornell index and SD+S_(V4)were positively correlated with LVMI.The voltages of R_(Ⅰ),R_(Ⅱ),R_(Ⅲ),S_(a VR),R_(a VL),R_(a VF),S_(V1),S_(V2),S_(V3),R_(V5),R_(V6),R_(Ⅰ)+S_(Ⅲ),R_(V5)+S_(V1),R_(V6)+S_(V1),R_(V6)+S_(V2),R_(a VL)+S_(V3)and SD+S_(V4)were positively correlated with RWT.(4)The proportion of ST-T changes in the centripetal hypertrophy group was higher than the othes.Conclusions Different left ventricular geometries had different electrocardiogram manifestations.Especially in patients with centripetal hypertrophy,there was a higher QRS voltage and a higher incidence of myocardial ischemia.

关 键 词：原发性高血压病 左心室几何构型 心电图特征 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]