平板运动试验ST-T改变合并U波倒置的观察与分析

Clinical observation on ST-T changes with U wave inversion in treadmill exercise test

目的探讨平板运动试验(TET)阳性患者中ST-T改变合并U波倒置者冠状动脉病变的情况及其临床意义。方法回顾分析60例TET阳性患者的冠状动脉造影结果,根据心电图是否出现ST-T改变合并U波倒置,分为ST-T改变伴U波倒置组(观察组,17例)与有ST-T改变无U波倒置组(对照组,43例),比较两组冠状动脉病变受累情况、冠状动脉狭窄的程度。结果观察组左主干病变、前降支病变、多支病变以及冠状动脉狭窄>85%的比率均高于对照组[29.4%(5/17)vs9.3%(4/43)、64.7%(11/17)vs34.9%(15/43)、70.6%(12/17)vs32.6%(14/43),88.2%(15/17)vs60.5%(26/43)],单支冠状动脉病变发生率对照组明显高于观察组[67.4%(29/43)vs29.4%(5/17)],差异均有统计学意义(P<0.05或<0.01)。结论 TET阳性患者中ST-T改变伴U波倒置者多支冠状动脉病变的发生率高,冠状动脉左主干和前降支的病变居多,狭窄程度重,范围广,临床上提示心功能较差、左室射血分数降低,应引起重视。

Objective To investigate the clinical significance of ST-T changes and U wave inversion in patients with positive treadmill exercise tests （TET） results. Methods The clinical data on coronary angiography of 60 patients with positive TET results were retrospectively analyzed. According to the fact whether there are ST-T changes combined with U wave inversion in their electrocardiography （ECG）, the patients were divided into the study group （n=17, ST-T changes combined with U wave inversion） and the control group （n=43, ST-T changes without U wave in- version. The culprit lesions, grades of coronary artery stcnosis were compared between the two groups. Results The rates of left main coronary artery stenosis, left anterior descending coronary artery stenosis, multi-vessel stenosis, coronary artery stenosis above 85% in the study group were higher than those in the control group [29.4% （5/17） vs 9.3% （4/43）, 64.7% （11/17） vs 34.9% （15/43）, 70.6% （12/17） vs 32.6% （14/43）, 88.2% （15/17） vs 60.5% （26/43）]. The rate of single-vessel stenosis in the control group was significantly higher than that in the study group [67.4% （29/43） vs 29.4% （5/17）]. Conclusion In patients with positive TET results, ST-T changes combined with U wave inversion suggested higher rates of multi-vessel stenosis, the left main coronary artery stenosis and left anterior descending coronary artery stenosis. The lesions of coronary artery diseases were severe, and the ranges of coronary artery diseases were wide. Their heart function was poor and the left ventricular ejection fraction was low clinically, which should be paid attention to.