P波离散度对房性心律失常的预测价值

The predictive value of P-wave dispersion in patients with atrial arrhythmia

目的探讨体表心电图P波离散度(Pwd)与房性心律失常(AR)的关系。方法无器质性心脏病的AR患者26例分为A组,合并器质性心脏病的AR患者30例分为B组,测量其体表心电图的Pwd、P波最大时限(Pmax)及左心房舒未直径(LAd)并与30例健康对照组C组对比分析。以Pmax≥110ms和Pwd≥40ms为阳性标准,评估Pmax、Pwd和Pmax+Pwd对AR的预测价值。结果A组、B组分别与C组比较Pmax、Pwd、LAd均有显著差异(P<0.05),A组与B组比较无显著差异(P>0.05)。Pmax≥110ms时,预测AR的敏感性为84.4%,特异性为82.5%,阳性预测值为81.8%;Pwd≥40ms时,预测AR的敏感性为85.7%,特异性为86.2%,阳性预测值为85.9%;当Pmax≥110ms+Pwd≥40ms时,预测AR的敏感性为78.7%,特异性为89.5%,阳性预测值为88.2%。结论体表心电图Pwd是预测AR的有效指标,而当Pmax与Pwd两者相结合时预测AR的特异性和准确性更高。

Objective To explore the relationship between P-wave dispersion（Pwd） of surface electrocardicgram（ECG） and atrial arrhythmia（AR）. Methods The P-wave maximal interval（Pmax） and Pwd were measured from 12-lead surface ECG, the left atrial diameter （IAd） were measured and compared in 56 patients with AR, and 30 healthy controls （C group）. AII AR patients were divided into two groups, group A included 26patients with not heart disease and group B included 30 patients with heart disease.The predictive value of Pmax,Pwd and combining the two targets were evaluated using Pmax≥110ms and Pwd≥40ms as the criteria. Results Pmax and Pwd were higher significantly in AR groups （A and B groups） than those in healthy controls （P〈0.05）. No significant difference existed in A and B groups （ P〉0.05）. Pmax≥110ms and Fwd≥40ms separated pantients from control group, with a sensitivity （84.4% and 85.7% ）, specificity （82.5% and 86.2% ） and with positive predictive value of 81.8% and 85.9%. Pmax≥110ms coexisted with Pwd≥40ms, Its sensitivity was 78.7%, specificity 89.5% and positive predictive value 88.2%. Conclusion Pwd is the effective ECG markers used to predict AR. Pmax ＋ Pwd were higher predictive value.