冠心病患者心电图平板运动试验假阴性的影响因素分析

Analysis of the influencing factors on the false negative of electrocardiogram treadmill exercise test in pa-tients with coronary heart disease

目的：探讨心电图平板运动试验假阴性的影响因素。方法将2012年1月至2015年6月在我院心内科进行心电图平板运动试验随后住院行CAG的170例冠心病患者纳入研究，心电图平板运动试验假阴性组80例，阳性组90例，回顾性分析两组患者的临床资料。结果（1）单因素分析：假阴性组CAG结果单支血管狭窄54例（67．50％），2支狭窄14例（17．50％），3支狭窄12例（15．00％）；阳性组分别为48例（53．33％）、34例（37．78％）、8例（8．89％），两组狭窄血管数目比较差异有统计学意义（χ2＝8．93，P＜0．05）。假阴性组冠状动脉血管狭窄部位的 ST段相互对应19例（23．75％），阳性组83例（92．22％）；两组冠状动脉有良好的侧支循环分别为61例（76．25％）、7例（7．78％），组间比较差异有统计学意义（χ2值分别为8．93、82．74，P＜0．01）。假阴性组与阳性组左回旋支、左前降支、左主干直径比较差异均有统计学意义[（3．58±0．95）、（3．47±0．15） mm，（4．25±0．11）、（3．94±0．17） mm，（4．58±0．37）、（4．37±0．26） mm，t值分别为2．91、6．80、2．06，P均＜0．05]。（2）将假阴性与阳性作为因变量，将狭窄血管数目、冠状动脉情况、左回旋支直径、左前降支直径和左主干直径作为自变量进行Logistic回归分析，结果发现左前降支直径是心电图平板运动试验假阴性的独立危险因素（ OR＝16．95，95％CI 3．58-80．27， P＜0．01）。结论冠心病患者心电图平板运动试验假阴性与冠状动脉直径有关，冠状动脉直径越宽，平板运动试验越易产生假阴性结果。

Objective To study the influencing factors on the false negative of electrocardiogram tread-mill exercise test.Methods One hundred and seventy cases coronary heart disease（ CHD） patients with coro-nary angiography and carried out electrocardiogram treadmill exercise test from January 2012 to June 2015 in Cardiology Department of the People’ s Hospital of Yanchang County were selected as research objects,including 80 cases of false negative and 90 of positive.The clinical data of two groups were analyzed retrospectively.Results （1）Single factor analysis：CAG results in the false negative group showed that there were 54 cases（67.50%） of single vessel stenosis,14 cases（17.50%） of two vessel stenosis,12 cases（15.00%） of three vessel stenosis,in positive group there were 48 cases（53.33%）,34 cases（37.78%） and 8 cases（8.89%） respectively,the differ-ences between the two groups was significant（χ2=8.93,P〈0.05）.The ST segment of the coronary artery stenosis in the false negative group was 19 cases（23.75%）,83 cases （92.22%） in the positive group.There were 61 ca-ses （76.25%） and 7 cases（7.78%） with good collateral circulation in the coronary artery of the two groups,re-spectively,the difference between the two groups was significant（χ2=82.74,P〈0.01）.There were significant differences in terms of left anterior descending artery（LCX）,left anterior descending branch（LAD）,left main trunk（LM） diameter between the two groups（（3.58±0.95） mm vs. （3.47±0.15） mm,（4.25±0.11） mm vs. （3.94±0.17） mm,（4.58±0.37） mm vs. （4.37±0.26） mm;t=2.91,6.80,2.06;P〈0.05）.（2）Considering false negative and positive as a dependent variable,and items with significance level including the number of narrow blood vessels,the diameter of coronary artery,LCX,LAD and LM diameters as independent variables in the sin-gle factor analysis,logistic regression analysis was carried out to find that LAD had significant difference in diam-eter,which was independent risk factor for the development of electrocardiogram exercise test false negatives（ OR=16.95,95%CI 3.58-80.27,P〈0.01）.Conclusion False negative is associated with coronary artery diameter for coronary heart disease patients after electrocardiogram treadmill exercise test.The wider coronary diameter is, the easier to produce false negative results in exercise treadmill test.