心电图碎裂QRS波联合心电向量图T环变化对缺血性心脏病的诊断价值  

Diagnostic value of fragmented QRS complex combined with T-loop changes in vectorcardiogram for ischemic heart disease

作　　者：董捍东 陈传奇 孙丽娟 袁泉 DONG Han-dong;CHEN Chuan-qi;SUN Li-juan;YUAN Quan(Department of Electrical Science,Henan Rongkang Hospital,Luoyang 471000,Henan,CHINA;Department of Internal Medicine,Henan Rongkang Hospital,Luoyang 471000,Henan,CHINA;Department of Medical Laboratory,Henan Rongkang Hospital,Luoyang 471000,Henan,CHINA)

机构地区：[1]河南省荣康医院电生理科,河南洛阳471000 [2]河南省荣康医院内科,河南洛阳471000 [3]河南省荣康医院医学检验科,河南洛阳471000

出　　处：《海南医学》2025年第7期992-995,共4页Hainan Medical Journal

基　　金：2023年度河南省医学科技攻关项目计划(编号:LHGJ2023080)。

摘　　要：目的探讨心电图碎裂QRS波(fQRS)联合心电向量图T环变化对缺血性心脏病的诊断价值。方法前瞻性选取2021年1月至2024年1月在河南省荣康医院接受治疗的125例疑似缺血性心脏病患者作为研究对象,所有受试者均行静息心电图fQRS检查、心电向量图T环改变检查,并以冠状动脉造影为金标准,比较两种检查方式的诊断准确率,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)评估两种检查方式在缺血性心脏病中的诊断价值。结果125例疑似缺血性心脏病中经冠状动脉造影检查确诊118例(94.40%)。fQRS对缺血性心脏病的诊断准确度为75.20%(94/125)、敏感度为77.97%(92/118)、特异度为28.57%(2/7)、阳性预测值为94.85%(92/97)、阴性预测值为7.14%(2/28);心电向量图T环改变对缺血性心脏病的诊断准确度为78.40%(98/125)、敏感度为80.51%(95/118)、特异度为42.86%(3/7)、阳性预测值95.96%(95/99)、阴性预测值11.54%(3/26);fQRS联合心电向量图T环改变对缺血性心脏病的诊断准确度为92.80%(116/125)、敏感度为93.22%(110/118)、特异度为85.71%(6/7)、阳性预测值为99.10%(110/111)、阴性预测值为42.86%(6/14);绘制ROC曲线,fQRS、心电向量图T环改变及两者联合检查结果的AUC分别为0.755、0.776、0.824,其中两者联合检查的准确度、敏感度最高。结论fQRS联合心电向量图T环变化在缺血性心脏病诊断中相较于单一检查,诊断价值更高,为临床心肌缺血诊断提供更可靠全面的参考依据。Objective To investigate the diagnostic value of fragmented QRS complex(fQRS)on electrocardiogram(ECG)combined with T-loop changes in vectorcardiogram(VCG)for ischemic heart disease(IHD).Methods A prospective study was conducted on 125 patients with suspected IHD who were treated at Henan Rongkang Hospital from January 2021 to January 2024.All participants underwent resting ECG for fQRS detection and VCG for T-loop changes.Coronary angiography was used as the gold standard for diagnosis.The diagnostic accuracy of the two methods was compared,and receiver operating characteristic(ROC)curves were plotted to calculate the area under the curve(AUC)to evaluate their diagnostic value for IHD.Results Among the 125 suspected IHD cases,118(94.40%)were confirmed by coronary angiography.The diagnostic accuracy,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of fQRS for IHD were 75.20%(94/125),77.97%(92/118),28.57%(2/7),94.85%(92/97),and 7.14%(2/28),respectively.For VCG T-loop changes,the corresponding values were 78.40%(98/125),80.51%(95/118),42.86%(3/7),95.96%(95/99),and 11.54%(3/26).When fQRS was combined with VCG T-loop changes,the diagnostic accuracy,sensitivity,specificity,PPV,and NPV improved to 92.80%(116/125),93.22%(110/118),85.71%(6/7),99.10%(110/111),and 42.86%(6/14),respectively.ROC curve analysis showed that the AUC values for fQRS,VCG T-loop changes,and their combination were 0.755,0.776,and 0.824,respectively.The combined method demonstrated the highest accuracy and sensitivity.Conclusion The combination of fQRS and VCG T-loop changes provides higher diagnostic value for IHD compared to either method alone,offering a more reliable and comprehensive reference for clinical diagnosis of myocardial ischemia.

关 键 词：心电图 碎裂QRS波 心电向量图 心肌缺血 缺血性心脏病 

分 类 号：R541[医药卫生—心血管疾病]