成人健康人群心电图正常范围的调查

Normal limits of the electrocardiogram in apparently healthy Chinese subjects

目的调查和评估我国成人健康人群心电图的正常范围。方法采集5360例（男性3614例，女性1746例，年龄范围18～84岁）健康人12导联同步心电图并按性别分为5个年龄组，计算和分析男、女各年龄组心电图参数的中位数及96％范围的正常上、下限，并比较其年龄和性别差异。结果PR间期、QTc间期、额面QRS电轴呈现明确的年龄趋势（P〈0．001）。PR间期、QRS波时限、QTc间期及不同导联QRS波和T波振幅存在明显的性别差异（P〈0．001）。男性PR间期上限值约为200ms，女性PR间期上限值从180ms随年龄增长逐渐增加到200ms。男性QRS波时限上限值为120ms，女性为109ms。各年龄组男、女性QTc间期上限值均〉440ms，女性QTc间期〉440ms的发生率（12．8％）明显高于男性（6．2％）。男性QRS电轴的正常范围为-37°～＋94°，女性为-27°～＋91°.Q波时限正常范围有明确的导联依赖性。在胸前导联，男性T波幅度的正常值不超过1．44mV，女性不超过0．9mV；在肢体导联，男性不超过0．54mV，女性不超过0．45mV。值得注意的是，肢体导联QRS振幅随年龄增长的变化规律与额面QRS电轴随年龄增长逐渐向左（上）偏移相一致；女性V，导联的R波振幅随年龄增长而增加。结论我国成人健康人群心电图参数存在明显的年龄及性别差异，适当调整传统的正常标准，可望进一步提高心电图诊断的质量。

Objective To investigate the normal limits of the electrocardiogram（ECG） in healthy Chi- nese subjects. Methods Standard simultaneous 12-lead ECG from 5360 apparently healthy Chinese（ 3614 men and 1746 women, ages ranging from 18 to 84 years）were collected with a modem digital recorder and processed with a well-validated ECG computer program. The medians,lower limits（ 2nd percentile）and upper limits（ 98th percentile） of various ECG measurements were calculated and age and sex differences examined. Results Significant age trends were present in PR interval, QTc interval and frontal QRS axis（ P 〈 0. 001 ）. Sex differences existed for PR interval,QRS darations,QTc interval and QRS and T amplitudes in different leads（ P 〈0. 001 ）. The upper limit of the PR interval was about 200 ms in men and in women, the upper limit gradually increased with age from 180 ms to 200 ms. The upper limit of QRS duration was about 120 ms for men and 109 ms for women. The prevalence of QTc 〉 440 ms was 12. 8% （ 223/1746 ） in women and 6. 2% （ 223/3614 ） in men. Normal limits of the frontal QRS axis was -37° ＋ 94° for men and -27°＋ 91° for women. Normal limit of Q-wave duration was markedly lead-dependent. The upper normal limits of T wave amplitude in limb leads was 0. 54 mV for men and 0. 45 mV for women, and in precardial leads 1.44 mV for men and 0. 9 mV for women. Notably,the changes of R-wave amplitudes in limb leads were concomitant with a frontal QRS axis shift to the left with age;the left-precordial R-wave amplitudes in women increased with age. Conclusions Normal ECG limits of healthy Chinese population show marked age and sex differences. Tuning of some traditional crite- ria may further improve the accuracy of ECG diagnosis.