P波离散度对甲亢患者并发房性心律失常的预测价值

Value of P-wave dispersion for the prediction of atrial fibrillation and atrial arrhythmia in patients with hyperthyrodism

目的:探讨体表心电图P波离散度(P-wave dispersion,Pd)对甲亢患者合并房性心律失常及房颤的预测价值。方法:选择103例甲亢患者进行24小时动态心电图检查及常规十二导心电图检查。根据是否合并房性心律失常的情况分为4组:A组(对照组)即单纯甲亢无房性心律失常组;B组为房早组,C组为短阵房速组;D组为阵发性房颤组。在为窦性心律时,依据常规十二导心电图测量P波时限,计算P波最大时限(Pmax),P波最小时限(Pmin)及Pd。结果:A、B两组Pmax、Pd比较均无显著差异(P>0.05),C、D组与A组Pmax、Pd比较差异有统计学意义(P<0.05);Pmax≥110ms预测房颤敏感性80%,特异性80%,阳性预测值77%;Pd≥40ms预测房颤敏感性84%,特异性83%,阳性预测值81%;Pmax≥110ms及Pd≥40ms合并预测房颤敏感性72%,特异性90%,阳性预测值88%。结论:Pmax、Pd可预测甲亢患者阵发性房颤发生,Pmax与Pd结合预测房颤的特异性和准确性更高。

Objective： To explore the value of P-wave dispersion（Pd） calculated with surface elec trocardiogram （ECG） for the prediction of atrial fibrillation and atrial arrhythmia in patients with hyper thyroidism. Methods： A total of 103 hyperthyroidism patients were divided into four groups according to the 24-hour dynamic electrocardiogram （DCG） and 12-lead electrocardiogram （ECG） results： group A, patients with simple hyperthyroidism group （control group）; group B： patients with atrial premature beats; group C： paroxysmal atrial tachycardia; group D： patients with paroxysmal atrial fibrillation. P wave duration, P-wave maximum duration （Pmax）, P-wave minimum （Pmin） duration, Pd of a sinus rhythm selected from the 12 lead electrocardiogram （ECG） tested belt were measured and compared. Resuits. No significant difference between Pmax and Pd value of group A and group B was found （P〉0.05）, while similar comparison between group C, D and group A showed significant difference（P〈0.05）. Criteria of Pmax≥110ms showed sensitivity, specificity and positive predictive value of 80%, 80%, 77%, and 84%, 83%, 81% when it was applied for the prediction of atrial fibrillation and atrial tachycardia, respectively, if combining with Pd≥ 40ms, the corresponding vale for atrial fibrillation raised to 72%, 90% and 88%. Conclusions： Pmax and Pd value, both alone and in combination, can be used for prediction of paroxysmal atrial fibrillation in patients with hyperthyroidism, and the combined two shows higher sensitivity and accuracy.