P波离散度对高血压病并发阵发性心房颤动患者的预测价值

Predictive value of P wave dispersion on paroxysmal atrial fibrillation in primary hypertensive patients

目的 探讨P波离散度(Pd)对高血压病患者阵发性心房颤动的预测价值。方法 Ⅰ组38例,为有阵发 性心房颤动病史的高血压病患者;Ⅱ组54例,为无阵发性心房颤动病史的高血压病患者。同步记录窦性心律时12导 联心电图,分别测定12导联P波时限[Pd=最大P波时限(Pmax)-最小P波时限(Pmin)],超声心动图测定左心房内径 (LAD)、左心室舒张末期内径(LVD)和左心室射血分数(LVEF)。以Pd≥40ms为阳性标准,检测阵发性心房颤动的 阳性率、灵敏性、特异性。结果 Pmax:Ⅰ组显著高于Ⅱ组[Ⅰ组与Ⅱ组比较:(127±15)ms对(110±12)ms,P< 0.001];Pd:Ⅰ组显著高于Ⅱ组[Ⅰ组与Ⅱ组比较:(53±13)ms对(39±10)ms,P<0.01];LAD:Ⅰ组高于Ⅱ组[Ⅰ 组与Ⅱ组比较:(46±9)mm对(41±7)mm,P<0.05];LVEF:Ⅰ组低于Ⅱ组[Ⅰ组与Ⅱ组比较:(51±6)%对 (58±6)%,P<0.05];Pmin、LVD两组差别无统计学意义。单因素回归分析显示:除LVD外,Pmax、Pd、LAD和 LVEF均是阵发性心房颤动的预测因子。多因素回归分析显示:Pd是阵发性心房颤动的独立预测因子。以Pd≥40 ms为阳性标准,检测阵发性心房颤动的Ⅰ组阳性率显著高于Ⅱ组(P<0.01),灵敏性84.2%、特异性85.2%。结论 Pd是高血压病患者发生阵发性心房颤动的独立预测因子,预测价值高。

Objective To investigate the predictive value of P wave dispersion(Pd) on paroxysmal atrial fibrillation(PAF) in primary hypertensive patients. Methods The maximum P wave duration(P max), the minimum P wave duration(P min) and Pd based on the 12-lead surface electrocardiogram were measured in 38 primary hypertensive patients with PAF (group Ⅰ) and 54 primary hypertensive patients without PAF (group Ⅱ). Pd=P max-P min. Left atrial dimension(LAD), left ventricular dimension in the end of diastolic(LVD) and left ventricular ejection fraction(LVEF) were also measured by echocardiography. Pd being≥40 ms was defined as positive, thus calculating sensitivity and specificity. Results P max in group Ⅰ was significantly higher than that in group Ⅱ [(127±15) ms vs (110±12) ms, P< 0.01]. Pd and LAD were changed in the same way as P max. Pd was [(53±13) ms vs (39±10) ms,P< 0.01]. LAD was [(46±9) mm vs (41±7) mm, P< 0.05]. LVEF in group Ⅰ was significantly lower than that in group Ⅱ [(51±6) % vs (58±6) %,P< 0.05]. In univariate analysis, P max, Pd, LAD and LVEF except LVD were significant predictors of PAF, whereas only Pd was a significant independent predictor of PAF in the multivariate analysis. Compared with group Ⅱ, the Pd positve rate was significantly higher in group Ⅰ (P< 0.01), and its sensitivity was 84.2%, specificity was 85.2% as the standard of Pd≥40 ms. Conclusion Pd is a significant independent predictor on PAF in primary hypertensive patients.