U波异常有助诊断缺血性心脏病-冠脉造影与心电图对照  

Abnormal U Waves in the Diagnosis of the Ischemic Heart Disease-Comparison between Coronary Arteriography and EKG

作　　者：郑志雄[1] 郑志萍[2] 马国庆[1] 钱学贤[3] 

机构地区：[1]空军杭州疗养院,浙江杭州310013 [2]福建医科大学附属一院,福建福州350004 [3]第一军医大学珠江医院,广东广州510082

出　　处：《高血压杂志》2003年第3期254-256,共3页Chinese Journal of Hypertension

摘　　要：目的　探讨U波异常在诊断缺血性心脏病中的价值。方法　选择临床拟为冠心病的男性患者 5 2例 ,排除电解质紊乱 ,应用常规心电图、运动负荷心电图及冠脉造影 ,分析ST段缺血性改变、U波异常在诊断缺血性心脏病中的敏感性和特异性。结果　 5 2例临床拟诊冠心病患者 ,冠脉造影阳性者 38例。冠脉造影阳性者中 ,常规心电图ST段呈缺血性改变者 16例 ,U波异常者 8例 ,其诊断缺血性心脏病的灵敏度分别为 4 2 11%、2 1 11% (16 / 38、8/ 38) ;运动试验阳性者 2 6例 ,运动诱发U波异常者 15例 ,其诊断缺血性心脏病的灵敏度分别为 6 8 4 2 %、39 4 7% (2 6 / 38、15 /38)。冠脉造影阴性者 (n =14 )中 ,常规心电图ST段无缺血性改变 6例 ,U波正常 13例 ,特异度分别为 4 2 86 %、92 86 % (6 / 14、13/ 14 ) ;运动负荷时 ,结果阴性 9例 ,U波正常 14例 ,特异度分别为 6 4 2 9%、10 0 % (9/ 14、14 / 14 )。运动负荷时尚见 2例单独U波异常 ,其冠脉造影证实有病理性狭窄。结论　U波异常在诊断缺血性心脏病中敏感性虽不如ST段下移的高 ,但U波异常的特异性高 ,尤其是运动诱发的U波异常更具诊断价值 ;缺血性U波异常有助诊断冠心病。Objective To study the diagnostic significance of abnormal U waves in the ischemic heart disease. Methods Fifty-two male patients with suspected coronary heart disease were subjected to routine electrocardiography, treadmill test and coronary arteriography. ECG ischemic ST segment and abnormal U waves were compared to the findings of the coronary arteriography . Results There were 38 patients with pathological coronary stenosis in coronary arteriography. Ischemic ST segments were found in 16, and abnormal U waves were 8 in resting ECG. Their sensitivity for diagnosing the ischemic heart disease were 42.1%, 21.1%, respectively. 26 patients showed ischemic ST segment depression and 15 with abnormal U waves in treadmill testing. The sensitivity for diagnosing the ischemic heart disease were 68.4%, 39.5%, respectively. Of 14 subjects with normal coronary arteriography, 6 cases had normal ST segments and 13 with normal U waves in resting ECG test were found. The specificity for the diagnosing of the ischemic heart disease were 42.9%, 92.9%, respectively. During treadmill testing, nine patients had normal ST sogment changes, and 14 normal U waves. Their specificity were 64.3%, 100%(9/14?14/14),respectively. There were 2 other cases with exercise-induced U waves as the only abnormal finding, who had pathological coronary stenosis in coronary arteriography. Conclusion Abnormal U waves is of high specificity for the diagnosis of ischemic heart disease, though its sensitivity is not as high as that of the depression of ST segment. Exercise-induced U waves is especially of significance in the diagnosis. The U wave criteria are helpful in the diagnosis of the coronary heart disease.

关 键 词：缺血性心脏病 诊断 心电图 U波异常 

分 类 号：R541.4[医药卫生—心血管疾病] R444[医药卫生—内科学]