健康人T波峰末间期及其离散度调查

Investigations on the Tpeak-Tend interval and the Tpeak-Tend interval dispersion in healthy individuals

目的 观察健康人T波峰末间期(TpTe)及其离散度和心率校正的TpTe(TpTe/√RR)及其离散度,分析TpTe和心率的关系,为临床进行TpTe 的研究提供适用的正常对照值.方法 选取1012名健康体检者,其12导联心电图T波在Ⅱ、Ⅴ3、Ⅴ4和Ⅴ5导联直立,终末部清晰可辨.分别测量标Ⅱ、V3、V4和V5导联QT间期、QTP间期(自QRS波群起点至T波最高点的时间),计算TpTe(TpTe = QT间期 - QTP间期)和TpTe 离散度,TpTe /√RR及其离散度.相关分析探究TpTe与心率的关系.结果 ① TpTe 各导联总均值为(84±10)ms,95%可信区间为64.87~103.71 ms.标Ⅱ导联TpTe 最短为(82±10)ms,Ⅴ4、Ⅴ5导联TpTe 相等且最长为(85±10)ms,标Ⅱ导联与Ⅴ3导联及Ⅴ4、Ⅴ5导联比较差异均有统计学意义(q=7.98,P＜0.01;q=8.07,P＜ 0.01),而Ⅴ3导联与Ⅴ4、V5导联比较差异无统计学意义(q=0.09,P＞0.05).TpTe离散度为(4±7)ms,95%可信区间为10.49~17.92 ms.TpTe及其离散度各导联性别和年龄组间差异均无统计学意义(P＞0.05).②TpTe/√RR各导联总均值为(92±12)ms,95%可信区间为69.07~114.47 ms.标Ⅱ导联TpTe/√RR最短为(89±11)ms,Ⅴ4、Ⅴ5导联TpTe/√RR相等且最长为(93±11)ms,标Ⅱ导联与Ⅴ3导联及Ⅴ4、Ⅴ5导联比较差异均有统计学意义(q=7.70,P＜0.01;q=7.58,P＜0.01),而Ⅴ3导联与Ⅴ4、Ⅴ5导联比较差异无统计学意义(q=0.124,P＞0.05).TpTe/√RR离散度为(4±8)ms,95%可信区间为11.95~19.64 ms.TpTe/√RR及其离散度各导联性别和年龄组间差异均无统计学意义(P＞0.05).③ 随着心率从60~100次/min渐次增快,QT间期逐渐缩短,二者呈显著负相关(r=-0.599,P＜0.01),而TpTe却无明显变化,与心率无相关性(标Ⅱ导联:r=-0.102,P＞0.05;Ⅴ3导联:r=-0.077,P＞0.05; Ⅴ4 =Ⅴ5导联:r=-0.084,P＞0.05).结论①得到了健康人TpTe及其离散度和TpTe/√RR及其离散度的参考值;②在正常心率范围,TpTe不受心率快慢的影响,不必进行心率校正.

Objective To investigate on the Tpeak-Tend interval (TpTe), the TpTe dispersion, the heart rate-corrected Tpeak-Tend interval (TpTe/√R-R), the TpTe/√R-R dispersion, and the relationship between the heart rates and the TpTe in healthy people. Methods One thousand and twelve healthy individals with T wave being positive and T wave end point being clear in limb leads Ⅱ and in chest leads Ⅴ3, Ⅴ4 and Ⅴ5 were included. 12 leads electrocardiogram was taken. QT interval and QTP interval (the distance from QRS complexs starting point to T wave end point) was measured in limb leads Ⅱ and in chest leads Ⅴ3, Ⅴ4 and Ⅴ5. TpTe (TpTe = QT interval - QTP interval ), TpTe dispersion, TpTe/√R-R and the TpTe/√R-R dispersion was calculated. The linear correlation was used to analyse (84±10)ms,95% confidence interval was 64.87-103.71 ms. TpTe was the shortest in lead Ⅱ [(82±10) ms] and the longest in chest leads V4 and Ⅴ5[Ⅴ4=Ⅴ5=(85±10) ms]. TpTe in lead Ⅱ was significantly shorter than those in lead Ⅴ3 and in leads Ⅴ4,V5(q=7.98,P＜0.01;q=8.07,P＜0.01). But TpTe was no significant different between lead Ⅴ3 and leads Ⅴ4,V5(q=0.09,P＞0.05). The TpTe dispersion was (4±7)ms,95% confidence interval was 10.49-17.92 ms. TpTe and the TpTe dispersion TpTe/√RR and the TpTe/√RR dispersion were (92±12) ms (69.07-114.47 ms, 95% confidence interval) and (4±8) ms(11.95-19.64 ms), respectively. TpTe / √RR was the shortest in lead Ⅱ [(89±11)ms] and the longest in chest leads Ⅴ4 and Ⅴ5[Ⅴ4 =Ⅴ5=(93±11) ms]. TpTe/√RR in lead Ⅱ was significantly shorter than those in lead Ⅴ3 and in leads Ⅴ4,V5(q=7.70,P＜0.01;q=7.58,P＜0.01). But TpTe / √RR was not significantly different between lead Ⅴ3 and leads Ⅴ4,V5(q=0.124,P＞0.05). TpTe/√RR and the TpTe/√RR dispersion were not obviously different in both sexes and the QT interval and there were no correlation between the heart rates and TpTe was identified in healthy people with the heart rates from 60 to 100 beats is not necessary that TpTe was corrected by the heart rates, when the heart rates are increasing from 60 to 100 beats per minute.