心电图P波离散度及Ⅱ导联P波峰值时间对原发性高血压患者新发心房颤动的预测价值  

Predictive values of electrocardiogram P wave dispersion and P wave peak time in leadⅡfor new-onset atrial fibrillation in patients with essential hypertension

作　　者：吴春蕾 杨盼 徐敏[1] 李瑛 王跃涛[2] WU Chunlei;YANG Pan;XU Min;LI Ying;WANG Yuetao(Department of Cardiac Function,the Third Hospital Affiliated to Soochow University,Changzhou,Jiangsu,213003;Department of Nuclear Medicine,the Third Hospital Affiliated to Soochow University,Changzhou,Jiangsu,213003)

机构地区：[1]苏州大学附属第三医院心功能科,江苏常州213003 [2]苏州大学附属第三医院核医学科,江苏常州213003

出　　处：《实用临床医药杂志》2024年第22期21-25,共5页Journal of Clinical Medicine in Practice

基　　金：常州市卫健委青年人才项目(QN202208);常州市“十四五”卫生健康高层次人才培养项目(KY20221362)。

摘　　要：目的探讨心电图P波离散度(PWD)与Ⅱ导联P波峰值时间(PWPTⅡ)对原发性高血压患者新发心房颤动(简称房颤)的预测价值。方法选择2021年7月—2023年6月在常州市第一人民医院诊断为新发房颤的原发性高血压患者120例为房颤组,选取年龄、性别相匹配的同期未发房颤的原发性高血压患者240例为对照组。通过电子病历系统收集入选患者近1年内窦性状态下的心电图。比较2组基本临床资料和心电图指标;采用二元Logistic回归分析探讨PWD、PWPTⅡ与原发性高血压患者新发房颤的相关性;绘制受试者工作特征(ROC)曲线,以组内相关系数(ICC)行观察者内及观察者间测量结果的一致性检验。结果房颤组的心率(HR)低于对照组,体表面积(BSA)、PR间期、PWD、PWPTⅡ均高于对照组,差异有统计学意义(P<0.05)。校正混杂因素(年龄、性别、HR、体质量指数、BSA)后,二元Logistic回归分析显示,PWD(OR=1.124,95%CI:1.095~1.155)和PWPTⅡ(OR=1.252,95%CI:1.186~1.320)与新发房颤显著相关(P<0.001)。ROC曲线分析显示,PWD与PWPTⅡ预测原发性高血压患者新发房颤的曲线下面积(AUC)分别为0.892、0.797,二者联合预测的AUC为0.910。观察者内及观察者间测量PWD和PWPTⅡ的一致性均极好(ICC>0.9)。结论心电图PWD联合PWPTⅡ预测原发性高血压患者新发房颤具有较高的应用价值。Objective To investigate the predictive values of electrocardiogram P wave dispersion(PWD)and P wave peak time in leadⅡ(PWPTⅡ)for new-onset atrial fibrillation in patients with essential hypertension.Methods A total of 120 essential hypertension patients diagnosed as new-onset atrial fibrillation in the First People′s Hospital of Changzhou City from July 2021 to June 2023 were selected as atrial fibrillation group,and 240 essential hypertension patients without atrial fibrillation in the same period matched by age and gender were selected as control group.Electrocardiograms under sinus rhythm were obtained from the patients in the last year through the electronic medical record system.The basic clinical data and electrocardiogram indexes were compared between the two groups;the correlations of PWD and PWPTⅡwith new-onset atrial fibrillation in patients with essential hypertension were analyzed by binary Logistic regression;the receiver operating characteristic(ROC)curve was drawn,and the intra-observer and inter-observer agreement tests were conducted by the intra-class correlation coefficient(ICC).Results Heart rate(HR)of the atrial fibrillation group was significantly lower than that of the control group,while the body surface area(BSA),PR interval,PWD and PWPTⅡwere significantly higher than those of the control group(P<0.05).After adjusting for confounding factors(age,gender,HR,body mass index,BSA),binary Logistic regression analysis showed that PWD(OR=1.124,95%CI,1.095 to 1.155)and PWPTⅡ(OR=1.252,95%CI,1.186 to 1.320)were significantly associated with new-onset atrial fibrillation(P<0.001).ROC curve analysis showed that the area under the curve(AUC)of PWD and PWPTⅡfor predicting new-onset atrial fibrillation in patients with essential hypertension was 0.892 and 0.797 respectively,and the AUC of combined prediction by PWD and PWPTⅡwas 0.910.Both the intra-observer and inter-observer agreement for PWD and PWPTⅡmeasurement were excellent(ICC>0.9).Conclusion Electrocardiogram PWD combined with P

关 键 词：心房颤动 原发性高血压 P波离散度 Ⅱ导联P波峰值时间 

分 类 号：R544.1[医药卫生—心血管疾病] R541.7[医药卫生—内科学] R540.4[医药卫生—临床医学]