肥胖对左心室肥厚心电图不同诊断标准的影响

Comparison of different electrocardiographic criteria in detecting left ventricular hypertrophy in obesity patients

目的研究肥胖对左心室肥厚(LVH)心电图不同诊断标准的影响。方法783例高血压患者按体质量指数(BMI)分为体质量正常组423例、超重组225和肥胖组135例。以超声心动图检查左室质量指数为诊断依据,对比不同心电图诊断标准(Sokolow-Lyon电压标准、Sokolow-Lyon乘积标准、Cornell电压标准和Cornell乘积标准)的漏诊率,分析不同心电图诊断标准受肥胖的影响。结果超声心动图诊断LVH患者433例,体质量正常组219例,超重组130例,肥胖组84例。Sokolow-Lyon电压标准的漏诊率最高,体质量正常组漏诊79例(36.1%)、超重组95例(73.1%)、肥胖组70例(83.3%),组间比较有显著差异(P<0.01)。Sokolow-Lyon乘积标准的漏诊率与Sokolow-Lyon电压标准相近。超重组和肥胖组与体质量正常组比较,Cornell电压标准和Cornell乘积标准对不同组患者诊断的漏诊率无显著差异(P>0.05)。Cornel乘积标准诊断的漏诊率低于其他3种心电图诊断标准的漏诊率。结论Cornell乘积标准诊断LVH的漏诊率最低,受超重和肥胖的影响最小,是肥胖患者LVH最有价值的心电图诊断标准。

Objective To study the influence of obesity on the diagnosis of electrocardiographic criteria in detecting left ventricular hypertrophy（LVH）.Methods 783 hypertensive patients were divided into 3 groups according to body mass index：normal weight group（ n = 423） ,overweight group（ n = 225） and obese group（ n = 135）. LVH diagnosed by echocardiography was used as references to test the rate of missed diagnosis of different electrocardiographie criteria （Sokolow-Lyon voltage criteria,Sokolow-Lyon voltage duration prodnct criteria, Gornell voltage criteria and Comell voltageduration product voltage）.Results LVH patients diagnosed by echocardiography were 219 in normal weight group, 130 in overweight group, and 84 in obese group. Sokolow-Lyon voltage criteria had the highest missed diagnosis rate of LVH, and missed 79 patients （36.1%） in normal weight group,95 patients （73.1%） in overweight group, and 70 patients （83.3%） in obese group. The difference among 3 groups was significant（ P 〈 0,01）.Sokolow-Lyon voltage-duration product criteria was similar to Sokolow-Lyon voltage criteria. The rate of missed diagnosis by Comell voltage and Comell voltage-duration product criteria, there was no significant difference between normal-weight patients and overweight and obese patients. The rate of missed diagnosis of LVH by Cornell voltage-duration product criteria was lower than by other three criteria. Conclusion Among these four criteria, Comell voltage duration product criteria had the lowest rate of missed diagnosis of LVH, and the effect of obesity on Comell voltage duration product criteria was lowest. It was of great value for detecting LVH in obesity hypertensive patients.