非ST段抬高型心肌梗死伴罪犯血管闭塞患者心电图征象及诊断价值  

ECG signs and diagnostic value in patients with non-ST-segment elevation myocardial infarction complicating culprit vessel occlusion

作　　者：罗艳华 王艳敏 徐燕爽 叶卉 LUO Yanhua;WANG Yanmin;XU Yanshuang;YE Hui(Department of Functional Examination,Pingdingshan Hospital of Traditional Chinese Medicine,Pingdingshan Henan 467000,China;Department of Heart Disease,Pingdingshan Hospital of Traditional Chinese Medicine,Pingdingshan Henan 467000,China)

机构地区：[1]平顶山市中医医院功能检查科,河南平顶山467000 [2]平顶山市中医医院心病科,河南平顶山467000

出　　处：《实用心电与临床诊疗》2025年第1期36-39,47,共5页PRACTICAL ELECTROCARDIOLOGY AND CLINICAL TREATMENT

基　　金：河南省中医药传承与创新人才工程(仲景工程)中医药拔尖人才项目(豫卫中医函〔2021〕15号)。

摘　　要：目的探讨非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)伴罪犯血管闭塞患者心电图征象及诊断价值。方法选取NSTEMI患者113例,根据有无血管闭塞将其分为血管闭塞组(50例)和非血管闭塞组(63例)。分析两组患者的心电图征象,包括ST段压低(ST-segment depression,STD)导联数,STD的最大值(STD_(max)),aVF、aVR、aVL导联ST段振幅,病理性Q波、孤立性STD、R波递增不良患者占比以及冠状动脉(简称冠脉)造影特征[前降支(LAD)、回旋支(LCX)、右冠脉(RCA)及其他]。采用ROC曲线分析,探讨心电图参数对NSTEMI伴罪犯血管闭塞的诊断价值。结果两组患者的性别、年龄、发病时间、糖尿病等一般资料比较,差异均无统计学意义(均P>0.05)。两组高血压、高脂血症、罪犯血管占比情况比较,差异均有统计学意义(均P<0.05)。与非血管闭塞组相比,血管闭塞组STD导联数更多,STD_(max)更大,aVF、aVR导联ST段振幅更大,病理性Q波、孤立性STD患者占比更高,且差异均有统计学意义(均P<0.05)。STD导联数、STD_(max)、aVF导联ST段振幅、aVR导联ST段振幅及其联合检测在NSTEMI伴罪犯血管闭塞诊断中的AUC值分别为0.662(0.560~0.764)、0.814(0.734~0.893)、0.691(0.594~0.788)、0.673(0.572~0.774)和0.864(0.799~0.929),敏感性分别为58.00%、84.00%、88.00%、70.00%和92.00%,特异性分别为68.30%、73.00%、54.00%、63.50%和69.80%。结论NSTEMI伴罪犯血管闭塞患者STD导联数较多,病理性Q波、孤立性STD患者比例较高,且心电图征象联合检测NSTEMI伴罪犯血管闭塞敏感性较高,可为NSTEMI伴血管闭塞的检出、诊断与治疗提供重要参考。Objective To investigate the ECG signs and their diagnostic value in patients with non-ST-segment elevation myocardial infarction(NSTEMI)complicating culprit vessel occlusion.Methods A total of 113 NSTEMI patients were selected,and divided into vascular occlusion group(50 cases)and non-vascular occlusion group(63 cases)according to the presence or absence of vascular occlusion.We analyzed the ECG signs of patients in the two groups,including the number of leads with ST-segment depression(STD),the maximum value of STD(STD_(max)),the amplitude of ST-segment in lead aVF,aVR and aVL,and the proportion of patients with pathological Q-wave,isolated STD and poor R-wave progression.We also analyzed the coronary angiography features[the left anterior descending branch(LAD),left circumflex branch(LCX),right coronary artery(RCA),and others].ROC curve analysis was used to explore the diagnostic value of ECG parameters for NSTEMI with culprit vessel occlusion.Results The sex,age,time of onset,diabetes and other general data did not vary signifiantly between the two groups(all P>0.05).There were statistically significant differences in the proportion of hypertension,hyperlipidemia and culprit vessels between the two groups(all P<0.05).Compared with the non-vascular occlusion group,the number of STD leads,STD_(max),the amplitude of ST-segment in lead aVF and aVR,and the proportion of patients with pathological Q-wave or isolated STD in the vascular occlusion group were greater,all with statistically significant differences(all P<0.05).The AUC values of the number of STD leads,STD_(max),the amplitude of STsegment in lead aVF,the amplitude of ST-segment in lead aVR,and the combined examination in the diagnosis of NSTEMI with culprit vessel occlusion were 0.662(0.560-0.764),0.814(0.734-0.893),0.691(0.594-0.788),0.673(0.572-0.774)and 0.864(0.799-0.929),respectively;the sensitivity was 58.00%,84.00%,88.00%,70.00%and 92.00%,respectively;the specificity was 68.30%,73.00%,54.00%,63.50%and 69.80%,respectively.Conclusion Among the NSTEMI

关 键 词：非ST段抬高型心肌梗死 罪犯血管闭塞 心电图征象 诊断价值 

分 类 号：R542.22[医药卫生—心血管疾病]