心电图ST段下移形态学与冠状动脉造影对比研究

The clinical discussion to relationship between electrocardiography ST-segment depression and coronary angiography

目的：探讨心电图ST段下移形态学改变与冠状动脉病变的关系。方法：对新疆医科大学第一附属医院2006年6月～2007年7月行冠状动脉造影的363例患者心电图及冠状动脉造影临床资料进行回顾性分析。男性266例（73．3％），女性97例（26．7％），平均年龄（57．3±10．98）岁，汉族263例（72．5％），维吾尔族76例（20．9％），其它少数民族24例（6．6％）。冠心病组235例，对照组128例。结果：冠状动脉狭窄单支病变者100例，双支病变56例，多支病变79例。冠心病组心电图ST段下移与对照组比较差异有统计学意义，用ST段下移预测冠状动脉狭窄的敏感度为63．0％，特异度为67．2％，假阳性率为32．8％，假阴性率为37．0％；冠脉狭窄单支病变与双支病变、多支病变心电图ST段下移分布结果差异有统计学意义，单支病变组ST段预测冠脉狭窄敏感度为73．0％，双支病变为55．4％，多支病变为55．7％。心电图ST段形态学下移型组内上斜型、下斜型、水平型与ST段正常组比较，差异均有统计学意义。汉族和维吾尔族冠心病组ST段下移型预测冠状动脉狭窄差异无统计学意义。结论：心电图ST段下移形态学改变提示冠状动脉狭窄的存在，该标准对单支病变预测的敏感度较高。ST段下移形态3种分型预测冠状动脉狭窄效果相同。ST段下移形态学标准预测冠状动脉狭窄价值在汉族和维吾尔族中一致。

Objective： This study goles to analyze the relationship of electro- cardiographic （ECG） ST-segment depression and coronary artery lesions. Methods： Three hundred and sixty three patients who underwent coronary angiography （CAG） in our hospital of Xin jiang Medical University from July 2006 to June 2007 were included in this study, and retrospective method was performed when CAG and ECG materials were analyzed. Results： 266 cases were male and 97 females （accounts for 73.3% and 26.7% respectively）, aged between 30-80 years （mean 57.3±10.98）. Among them, 263 cases were Han, 76 were Uyger and 24 were another minorities （accounts for72.5%, 20.9% and 6.6%, respectively）. 235 cases were with coronary artery lesions 100 cases were with single-vessel lesion, 56 with double-vessel lesion and 79 with poly- vessel lesion and 128 were normal controls. Patients with coronary artery lesions had significantly ST-segment depressed on resting ECG comparing with normal controls. The senstivity, specificity, false positive ratio and false negative ratio were 63%, 67.2%, 32.8% and 37% respectively when predicting the stenosis using ST-segment depression. There were significantly statistical differences of ST-segment depression among patients with single-vessel lesion, double-vessel lesion and poly- vessel lesion （The senstivity among these three groups were 73%, 55.4% and 55.7% respectively）. There were statistical differences among the ST upslope, downslope, level and no ST-depression groups, while no difference was showed when paired T test was performed. There was no significantly statistical difference between Han and Uygur with ST-segment depression for stenosis predicting. Conclusion： The ST-segment depression on resting ECG may partially suggest the coronary artery stenosis. This method seems more sensitive in single-vessel group than in double-vessel and poly- vessel groups. Upslope, downslope and level groups in ST depression have similarly sensitivity and accuracy in predict the coronary stenosis. The predicting value of ECG ST-segment depression for the coronary stenosis are similar in Han and Uygur.