12导联动态心电图ST段压低诊断冠心病的价值

Diagnosis value of ST depression in 12-lead Holter in Coronary atherosclerotic heart disease

目的探讨24h12导联动态心电图ST段压低诊断冠心病的临床意义。方法将163例12导联动态心电图检查有缺血性ST段压低伴或不伴典型胸痛患者分为两组(A组ST段压低伴典型胸痛者88例,B组ST段压低不伴典型胸痛或无症状者75例),并与冠状动脉造影进行对比分析。结果A组88例冠状动脉造影明显狭窄79例,其中单支病变44例,双支病变25例,3支病变10例,而B组75例冠状动脉造影明显狭窄15例。以冠状动脉造影阳性为标准,A组对冠心病的诊断阳性率为89.77%,特异性为80.00%,准确度为85.28%。而B组阳性率仅为20.00%,两组阳性率差异有非常显著性意义(χ2=80.75,P<0.01)。结论12导联动态心电图检查缺血性ST段压低伴有典型胸痛,诊断冠心病的价值要优于仅有ST段改变者,前者阳性率和准确度较高,具有重要的临床应用价值。

Objective To evaluate diagnosis value of ST depression in 12-lead Hoher in coronary artery disease. Methods 163 cases with ischemic ST segment changes in 12-lead Holter were divided into group A （88 cases） with typical chest pain or group B （75 cases） without typical chest pain. All cases received coronary artery angiography. Results In group A, 79 cases had significant coronary artery stenosis. Of them, 44 cases had single vessel disease, 25 cases had two vessels disease and 10 cases had three vessels disease. Positive rate, specificity and accuracy of 12-lead Holter in diagnosis of coronary artery disease were 89.77%, 80.00%, and 85.28%, respectively. In group B, 15 cases had significant coronary artery stenosis. Diagnosis positive rate was 20.0% in group B and significantly lower than that in group A（P〈0.01）. Conclusion ST depression in 12-lead Holter may be more valuable in diagnosis of coronary artery disease in patients with than without typical chest pain.