空间QRS-T夹角与空间Tp-Te间期的相关性分析

Correlation Analysis of Spatial QRS-T Angle and Tp-Te Interval during treadmill exercise test

目的本文通过分析平板运动试验中,空间QRS-T夹角与空间Tp-Te间期的动态变化以及它们之间的相关性,为心脏危险因素提供新的预测方向。方法入选2013年10月到2014年1月于大连医科大学附属第一医院行平板运动试验检查的成年人40例,所有受试者均排除先天性心脏病、器质性心脏病,收集正常健康人群平板运动试验中不同时段QRS-T夹角和Tp-Te间期,并且在接受平板运动试验前均未服用影响心率的药物,各组患者在年龄、性别方面差异无统计学意义,具有可比性。连续同步检测体表12导联心电图并分别在运动前、运动结束、运动结束后1、4、9min采集心电向量图。分析运动前、运动结束以及运动结束后第1、4、9min的QRS-T夹角和Tp-Te间期的动态变化,以及二者的相关性。结果 (1)运动不同时程的QRS-T夹角动态变化的均值与标准差:运动前7.23±3.58,p<0.05;运动结束9.87±4.64,p<0.05;运动结束后1min 9.56±4.35,p<0.05;运动结束后4min 8.29±4.26,p<0.05;运动结束后9min 8.27±4.50,p<0.05。单因素方差分析和多重比较表明QRS-T夹角运动前、运动结束、运动结束后1min各组间变化最显著,差异具有统计学意义。QRS-T夹角随时间变化较Tp-Te间期更敏感;(2)运动不同时程Tp-Te间期动态变化的均值与标准差:运动前1.67±2.75,p<0.05;运动结束1.74±2.63,p<0.05;运动结束后1min 1.76±2.29,p<0.05;运动结束后4min 1.77±1.63,p<0.05;运动结束后9min 1.79±1.73,p<0.05。单因素方差分析表明Tp-Te间期各组间不具有统计学差异;(3)通过Pearson相关,对各组QRS-T夹角和Tp-Te间期进行相关性分析:其中各组Pearson R值和p值分别为:运动前(R=0.089,p>0.05)、运动结束(R=-0.063,p>0.05)、运动结束后1min(R=0.096,p>0.05)、运动结束后4min(R=-0.255,p>0.05)、运动结束9min(R=-0.041,p>0.05)。各分组R均小于0.8,p均大于0.05,差异无统计学意义,二者没有相关性。校正前、后全部(不分组)QRS-T夹角与Tp-Te间期进行相关性分析,p均大于0.05,差异无统计学意义,二者没有相关性。结论 (1)平板运动试验中截取的空间QRS-T夹角在运动前、运动结束、运动结束后1min,各分组之间存在显著性差异,具有统计学意义;(2)平板运动试验中截取的空间Tp-Te间期在运动前、运动结束、运动结束后1、4、9min各分组之间差异不具有统计学意义;(3)空间QRS-T夹角较空间Tp-Te间期随时间变化更敏感,空间QRS-T夹角与空间Tp-Te间期不具有相关性。

Objective By analyzing the dynamic change and correlation between spatial QRS-T angle and spatial Tp-Te interval during exercise treadmill test（treadmill exercise test, TET） as well as before and after correction, provides a new direction to predict cardiac risk factors. Methods Selecting 40 adult cases who accepted treadmill exercise test at the first affiliated hospital of dalian medical university from October 2013 to January 2014,all the subjects were excluded from congenital heart disease, organic cardiopathy. Collected normal healthy people QRS-T angle and Tp-Te interval data at different times during treadmill exercise test, and make sure nobody take heart rate affecting drug before test. Patients in each group were no statistically significant differences in age and gender, so were comparable. Continuously synchronized detection on body surface 12-lead ECG and collected VCG before exercise, finish exercise, 1,4,9-min after exercise. After analysis of the dynamic change and correlation between QRS-T angle changes and Tp-Te intervals on the five VCG of above exercises. Results（1）The average value and standard deviation of spatial QRS-T angle of dynamic changes. Before movement（7.23 ±3.58, p 〈0.05）;movement end（9.87±4.64, p〈0.05）; 1 minute after movement end（9.56±4.35, p〈0.05）; 4 minutes after movement end,（8.29±4.26, p〈0.05）; 9 minutes after movement end（8.27±4.50, p〈0.05）. One-way ANOVA and multiple comparisons show that spatial QRS-T angle before exercise, exercise end, and 1 minute after exercise end, the change is most obvious, with statistical significance.（2） The average value and standard deviation of spatial Tp-Te interval dynamic changes. Before movement（1.67±2.75, p〈0.05）; movement end（1.74±2.63, p〈0.05）; 1 minute after movement end（1.76±2.29, p〈0.05）; 4 minutes after movement end（1.77±1.63, p〈0.05）; 9 minutes after movement end（1.79 ±1.73, p 〈0.05）. One-way ANOVA shows that Tp-Te intervals between each group have no significant difference.（3）By Pearson correlation, analyze the correlation of QRS-T angle and Tp-Te interval for each group before correction. Pearson R value and P value for each group, before movement（R=0.089, p 〉0.05）;movement end（R=-0.063, p〉0.05）; 1 minute after movement end（R=0.096, p〉0.05）; 4 minutes after movement end（R=-0.255, p〉0.05）; 9 minutes after movement end（R=-0.041, p〉0.05）. Each group R values were less than0.8. P values were greater than 0.05. There was no statistically significant difference and had no correlation between them. Analyzing the correlation of all QRS-T angles and Tp-Te intervals（not by group） before and after correction,there was no statistically significant difference as P values were greater than 0.05, no correlation between them.Conclusions（1） Spatial QRS-T angle intercepted from treadmill exercise when before, finish, 1 min after exercise,there are significant differences between each group, with statistical significance.（2） There was no significant difference on spatial Tp-Te intervals intercepted from treadmill exercise test when before, finish and 1,4,9-min after exercise, so without statistical significance.（3） Spatial QRS-T angle is more sensitive than Tp-Te interval with time change, Spatial QRS-Tangle and spatial Tp-Te interval is not relevant.