QT离散度联合ST/心率斜率及ST段标准诊断经皮冠状动脉介入术后再狭窄的研究

Association of QT dispersion,ST/heart rate slope and ST-segment depression in exercise test to evaluate restenosis after percutaneous coronary intervention

目的探讨心电图运动试验（EET）测定多项指标联合传统ST段标准诊断冠心病介入治疗后再狭窄的敏感性和特异性。方法2001年11月—2003年12月,对成功行经皮冠状动脉介入治疗（PCI）的129例患者在术后3-6个月进行随访,测量其EET、ST/心率斜率（ST/HRs）、QT离散度（QTd）及常规ST段阳性标准,将三者联合起来诊断PCI后再狭窄,通过冠状动脉造影确定有无再狭窄,评价其诊断再狭窄的价值。结果在传统ST段诊断标准基础上联合QTd及ST/HRs诊断再狭窄的敏感性和特异性分别为84.6%和80.4%,明显高于传统ST段诊断标准（敏感性为53.3%,特异性为66.7%,P〈0.05）。结论QTd联合ST/HRs及传统ST段标准可作为冠心病术后再狭窄的无创诊断手段。

Objective To evaluate the sensitivity and specificity of QT dispersion （QTd） and ST/heart rate slope （ST/HRs） at the end of ECG exercise test plus ST-segment depression on diagnosing restenosis after percutaneous coronary intervention （PCI）. Methods Between November 2001 and December 2003, 129 patients underwent PCI successfully, and they were examined 3-6 months later. At the end of treadmill exercise, QTd and ST/HRs were measured. All patients also accepted coronary angiography to ascertain whether he/she had restenosis. The results of QTd and ST/HRs plus ST-segment depression were then evaluated. Results The sensitivity and specificity of QTd and ST/HRs plus ST-segment depression were 84.6% and 80.4% respectively. Both of them were significantly higher than conventional ST-segment depression standard （sensitivity was 53.3% and specificity was 66.7%, P〈0.05）. Conclusion Measuring QTd and ST/HRs at the end of ECG treadmill exercise test plus ST-segment depression can be used for the diagnosis of restenosis after PCI.