大致正常心电图中Tp-Te间期预测冠状动脉重度狭窄的临床研究  

Clinical Study on the Prediction of Severe Coronary Artery Stenosis by Tp-Te Interval in Approximately Normal Electrocardiograms

作　　者：杨艳丽[1,2,3] 李颖 习诗良[4] Yang Yanli;Li Ying;Xi Shiliang(Department of Electrocardiogram,Yichang Central People's Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China;Hubei Key Laboratory of Ischemic Cardiovascular Disease,Yichang 443003,China;Hubei Provincial Clinical Research Center for Ischemic Cardiovascular Disease,Yichang 443003,China;Department of Pain Medicine,Yichang Central People's Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China)

机构地区：[1]三峡大学第一临床医学院[宜昌市中心人民医院]心电诊断科,湖北宜昌443003 [2]缺血性心血管病湖北省重点实验室,湖北宜昌443003 [3]湖北省缺血性心血管疾病临床医学研究中心,湖北宜昌443003 [4]三峡大学第一临床医学院[宜昌市中心人民医院]疼痛科,湖北宜昌443003

出　　处：《巴楚医学》2025年第1期49-53,共5页Bachu Medical Journal

基　　金：中央引导地方科技发展专项基金项目(2022BGE237);三峡大学科学基金项目(2022kj008);三峡大学科学专项基金项目(2023kjzx001)。

摘　　要：目的:通过分析大致正常心电图中T波峰末间期(Tp-Te间期)的变化,探讨Tp-Te间期是否可用于预测冠状动脉重度狭窄。方法:收集2020年1月—2024年5月在宜昌市中心人民医院行冠状动脉CT血管造影检查的患者663例,其中合并前降支重度狭窄(狭窄程度≥90%)的患者为病例组(n=146),完全无狭窄且无其它异常的患者为对照组(n=517)。收集两组患者的心电图记录,测量Tp-Te间期。采用Logistic回归模型绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),绘制约登指数曲线,明确Tp-Te间期诊断冠状动脉重度狭窄的阈值、敏感性和特异性。结果:与对照组相比,病例组V1[(82.91±18.73)ms vs(72.31±15.22)ms]、V2[(90.48±16.86)ms vs(84.23±13.45)ms]、V3[(90.13±16.04)ms vs(83.11±14.79)ms]、V4[(88.86±15.03)ms vs(71.12±13.94)ms]的Tp-Te间期均明显升高(均P<0.001)。V1~V4的Tp-Te间期及联合预测的AUC值分别为0.691、0.582、0.573、0.714、0.633。当V4导联Tp-Te间期为79.5 ms时,预测的敏感性为74.66%,特异性为77.40%,为临床预测时的最佳平衡点52.06%。结论:Tp-Te间期可预测重度冠状动脉狭窄,V4导联效应量最大,预测效能最高,Tp-Te间期的阈值为79.5 ms。Objective:By analyzing the changes in the T wave peak-to-end interval(Tp-Te interval)in approximately normal electrocardiograms,this study explores whether the Tp-Te interval can be used to predict severe coronary artery stenosis.Methods:A total of 663 patients who underwent coronary CT angiography at Yichang Central People's Hospital between January 2020 and May 2024 were collected.Among them,patients with severe stenosis(≥90%narrowing)of the left anterior descending artery were assigned to the case group(n=146),while patients with no stenosis and no other abnormalities were assigned to the control group(n=517).ECG records of both groups were collected,and the Tp-Te intervals were measured.Logistic regression model was used to plot the receiver operating characteristic(ROC)curve,calculate the area under the curve(AUC),and draw the Youden index curve to determine the threshold,sensitivity,and specificity of the Tp-Te interval for diagnosing severe coronary artery stenosis.Results:Compared with the control group,the Tp-Te intervals in V1[(82.91±18.73)ms vs(72.31±15.22)ms],V2[(90.48±16.86)ms vs(84.23±13.45)ms],V3[(90.13±16.04)ms vs(83.11±14.79)ms],and V4[(88.86±15.03)ms vs(71.12±13.94)ms]were significantly increased in the case group(all P<0.001).The AUC values for V1 to V4 and the combined prediction were 0.691,0.582,0.573,0.714,and 0.633,respectively.At a Tp-Te interval of 79.5 ms in V4,the sensitivity for prediction was 74.66%,and the specificity was 77.40%,representing the optimal balance point for clinical prediction at 52.06%.Conclusion:The Tp-Te interval can predict severe coronary artery stenosis,with the largest effect size and highest predictive efficacy in V4.The threshold for the Tp-Te interval is 79.5 ms.

关 键 词：心电图 冠状动脉狭窄 TP-TE间期 

分 类 号：R541.4[医药卫生—心血管疾病]