动态心电图时域法检测MTWA对冠心病的诊断价值研究

Study on the relationship between MTWA and coronary heart disease by dynamic electrocardiogram time domain method

目的 探讨动态心电图时域法检测微伏级T波电交替（MTWA）对冠心病的诊断价值.方法 选取2015年2月至2017年2月在我院治疗的冠心病患者112例,其中冠脉狭窄＜50％患者44例（A组）,冠脉狭窄50％～75％患者31例（B组）,冠脉狭窄＞75％患者37例（C组）,同时选取冠脉造影正常者40例作为对照（D组）,采用动态心电图分析软件记录24h动态心电图,分析各组MTWA阳性率.结果 C组MTWA阳性率为43.24％,明显高于A组、B组和D组（P＜0.05）;而A组、B组和D组MTWA阳性率比较差异无统计学意义（P＞0.05）;单支病变组、双支病变组和三支病变组MTWA阳性率比较无统计学意义（P＞0.05）.MTWA阳性者发生恶性室性心律失常比例为34.62％,明显高于MTWA阴性者,差异有统计学意义（P＜0.05）;MTWA阳性预测室性心律失常特异度、灵敏度、阴性预测值和阳性预测值分别为86.07％、30.00％、83.33％和34.62％.结论 MTWA在评估冠心病危险程度中有一定的应用价值,但在预测冠心病患者发生恶性室性心律失常中的应用价值较低.

Objective To investigate relationship of dynamic electrocardiogram detection time domain method microvolt T wave alternant （MTWA） with coronary heart disease.Methods 112 patients with coronary heart disease treated in our hospital from February 2015 to February 2017 were selected,among them,coronary stenosis〈50% in 44 patients （group A）,coronary stenosis was 50%-75% in 31 patients （group B）,and coronary stenosis〉75% in 37 patients （group C）,40 patients with normal coronary angiography were selected as control group （group D）,the 24 h dynamic electrocardiogram was recorded by Beneware dynamic electrocardiogram analysis software,and the positive rate of MTWA in each group was analyzed.Results The positive rate of MTWA in group C was 43.24%,which was evidently higher than that in group A,group B and group D（P〈0.05）,but there was no significant difference in the positive rate of MTWA between group A,group B and group D （P〉0.05）.The positive rate of MTWA in single branch disease group,double branch disease group and three branch disease group was not statistically significant（P〉0.05）.The percentage of malignant venticular arrhythmias in MTWA positive patients was 34.62%,higher than that in MTWA negative patients,and the difference was statistically significant （P〈0.05）.The sensitivity,specificity,positive predictive value and negative predictive value of MTWA positive for predicting malignant ventricular arrhythmias were 30%,86.07%,34.62% and 83.33%,respectively.Conclusion MTWA has a certain value in assessing the risk of coronary heart disease,and has low value in predicting the occurrence of malignant ventricular arrhythmia in patients with coronary heart disease.