静息状态下心电图指标对冠心病多支病变诊断价值的比较

Application of resting electrocardiogram in diagnosis of multiple-vessels lesion in coronary heart disease

目的探讨静息状态下常规十二导联心电图对冠心病患者(非急性心肌梗死、无胸痛发作状态)冠状动脉(冠脉)多支病变的诊断价值。方法观察分析1999年11月至2006年1月于济南市第四人民医院心内科入院拟诊不稳定型心绞痛行冠状动脉造影(CAG)患者(104例)的造影资料及CAG前ECG资料。选择性多体位左、右冠状动脉造影,以左主干、前降支、回旋支、右冠状动脉中任一支狭窄≥50%者为阳性,将患者分为阴性组(8例)、多支病变组[30例,LAD+LCX+RCA和(或)左主干病变]和非多支病变组(66例,单支病变+双支病变)。其中,左主干病变14例(可并发单支、双支或3支病变)。计数各组病例心电图aVR导联ST段抬高病例数、异常导联数、ST段移位绝对值之和、异常导联数+ST段移位绝对值之和、ST段时间,进行统计学分析。结果异常导联数+ST移位、异常导联数、ST段时间、aVR导联ST段抬高,多支病变组与非多支病变组比较有显著差异。异常导联数+ST移位、异常导联数和ST移位的敏感性显著高于aVR导联ST抬高,异常导联数+ST移位的敏感性明显高于ST移位。aVR导联ST抬高和ST移位特异性最好,两者之间无明显差异。结论异常导联数+ST移位、异常导联数、ST移位是诊断冠心病多支病变的敏感指标,且均优于aVR导联ST抬高;异常导联数+ST移位的敏感性明显高于ST移位。

AIM To study the relation of 12-lead resting electrocardiographic features and multiple-vessel coronary artery lesions and to evaluate its value in predicting multiple-vessel coronary artery lesion. METHODS One hundred and four patients were divided into three groups： negative group （ NG）, multiple-vessel lesion group （MVLG） and non-multiple-vessel lesion group （NMVLG）. Electrocardiogram （ECG） and coronary artery angiography （CAG） were observed in all the patients. We analyzed the general characteristics, the absolute value of ST-segment deviation, ST-segment elevation in lead aVR, the number of leads with abnormal ST segment, the absolute value of ST-segment deviation plus the number of leads with abnormal ST segment and ST segment time between NMVLG and NMVLG. RESULTS Significant differences were found between MVLG and NMVLG for the number of leads with abnormal ST segments plus ST-segment deviation, the number of leads with abnormal ST segment, the ST segment deviation, and ST segment time, all more sensitive than ST-segment elevation in lead aVR. The sensitivity of the number of leads with abnormal ST segments plus ST-segment deviation was higher than that of ST-segment deviation. The specificity of ST-segment elevation in lead aVR and the ST segment deviation was the best, with no significant difference between them. CONCLUSION The number of leads with abnormal ST segment plus ST-segment deviation, the number of leads with abnormal ST segment and the ST-segment deviation are all sensitive indexes in diagnosing multiple-vessel coronary artery lesions, and better than the ST-segment elevation in lead aVR. The sensitivity of the number leads of with abnormal ST-segment plus ST-segment deviation is higher than that of ST-segment deviation.