区域性QT间期差对高血压和冠心病的鉴别诊断价值

The Value of Regional QTd for the Differential Diagnosis of Coronary Heart Disease and Hypertension

目的 研究区域性QT间期差（QTrd）与高血压、冠心病两种不同疾病引起心肌缺血的关系。方法 选择87例因体表心电图ST段异常改变的住院病人。经冠状动脉造影后分为单纯冠心病组及高血压组。据体表12导联心电图分为Ⅰ、aⅤL，Ⅱ、Ⅲ、aⅤF，Ⅴ2～4，Ⅴ5～6 4个区域，测量各区域的QTrd并进行分析。结果 在Ⅰ、aⅤL区域，各组都有部分QTrd≥40ms；Ⅱ、Ⅲ、aⅤF，Ⅴ2～4，Ⅴ5～6 3个区域有一个区域的QTrd≥40ms的百分比在高血压组为65％。冠心病组无一例大于40ms。结论 在高血压病时，如心电图出现ST段异常改变。在Ⅱ、Ⅲ、aⅤF，Ⅴ2～4，Ⅴ5～6这3个区域中，有一个区域的QTrd〉40ms，则提示高血压心肌肥厚伴缺血的可能性大。若这3个区域中的QTrd均〈40ms，则冠状动脉病变引起心肌缺血的可能性大。

Objective To study the relationships between regional QTd （QTrd） and myocardial ischemia caused by hypertension or coronary heart disease （CHD）. Methods According to the changes of ST segment in ECG and coronary angiography, 87 cases were divided into two groups： Coronary heart disease （CHD） group and hypertension （HT） group. QTrd was measured and compared in four regions （lead Ⅰ and aⅤL; lead Ⅱ , Ⅲ, aⅤF; lead Ⅴ2-4 and lead Ⅴ5-6） of ECG in each group. Results QTrd ≥40 ms was seen in the region of lead Ⅰ and aⅤL in two groups, The rate of QTrd≥40 ms in one of the other three regions was 65 % and 0 % in HT group and CHD group respectively. Conclusion The QTrd was useful for differential diagnosis of coronary heart disease and hypertension.