冠心病患者T波电交替检测分析

T-Wave Alternans Test in patients with coronary heart disease

目的采用12导联高分辨率动态心电图(12-HR-HOLTER)对冠心病患者及非冠心病患者作12-HR-HOLTER记录并进行微伏级(uV)TWA时域及频域检测分析,探索12-HR-HOLTER的TWA检测方法和评价指标。方法选择冠心病患者170例为Ⅰ组,其中男112例,女58例,平均年龄64.49±11.68岁,高血压患者114例为Ⅱ组,其中男45例,女69例,平均年龄63.09±12.57岁,及非心血管病患者67例为Ⅲ组,其中男30例,女37例,平均年龄61.37±9.59岁,分别记录12-HR-HOLTER,并进行TWA检测分析。结果①冠心病组(Ⅰ组)TWA事件明显高于高血压组(Ⅱ组)及非心血管病组(Ⅲ组,177.97±794.99,0.70±2.56,0.63±1.92,p<0.01);②TWA事件主要检测指标为TWA发生阵/次(TWA-E),TWA持续时间(TWA-HOUR)及TWA心搏数(TWA-BEAT);Ⅰ组TWA事件各项指标均明显高于Ⅱ、Ⅲ组(p<0.01);③Ⅱ组及Ⅲ组检出少量TWA事件,二组间各项TWA检测指标均无显著性差异(p>0.05),冠心病组(Ⅰ组)TWA阳性率(16.47%)明显高于Ⅱ、Ⅲ组(0.88%,1.49%,p<0.01)。结论①12-HR-HOLTER记录检测分析方法可对微伏级TWA进行频域和时域检测分析;②冠心病患者TWA的发生率明显高于高血压患者及非心血管病患者;③TWA发生阵/次(TWA-EVENT)、TWA持续时间(TWA-HOUR)及TWA心搏数(TWA-BEAT)等参数可作为TWA检测评价的定量指标。

Objective To record the 12-lead high resolution HOLTER（12-HR-HOLTER） and test T-Wave Alternans（TWA） in time and frequency domain for the patients with and without coronary heart disease.Methods The 12-HR-HOLTER was recorded and TWA was tested in 170 patients with coronary heart disease（GroupⅠ,112 males,58 females,64.49±11.68 years old）,114 patients with hypertension（GroupⅡ,45 males,69 females,63.09±12.57 years old） and 67 cases without cardiovascular disease（GroupⅢ,30 males,37 females,61.37±9.59 years old）.Results ①The positive rate of TWA in Group I was significantly higher than that of GroupⅡand Group Ⅲ（16.47%,0.88%,1.49%,p〈0.01）;②TWA events（TWA-EVENT）,TWA persisting hours（TEA-HOUR） and TWA heart beats（TWA-BEAT） were used to detect and evaluate TWA;③TWA-EVENT of GroupⅠ was significantly more than that of GroupⅡand GroupⅢ（p〈0.01）;TWA-HOUR and TWA（TWA-BEAT were significantly more in GroupⅠthan that of GroupⅡand GroupⅢ（p〈0.01）.Conclusions ①Microvolt TWA could be tested by the methods of 12-HR-HOLTER recording and analyzing;②TWA is highly positive in patients with coronary heart disease;③TWA-EVENT,TWA-HOUR and TWA-BEAT could be used as the main indexes to test and evaluate TWA.