心电图检测在变异性心绞痛患者恶性室性心律失常中的预测价值分析

Predictive value of electrocardiogram test for malignant ventricular arrhythmia in patients with variant angina

目的探讨心电图检测在变异性心绞痛(variant angina,VA)患者恶性室性心律失常(malignant ventricular arrhythmia,MVA)中的预测价值,为VA患者MVA的发生提供可靠监测依据。方法选取2013年6月—2017年6月绍兴市新昌人民医院收治的VA患者90例,其中将67例单纯VA患者纳入VA组,23例VA合并MVA患者纳入MVA组,比较2组患者心电图参数,采用Logistic回归分析对心电图参数和MVA的关系进行研究,采用ROC曲线下面积(AUC)分析心电图参数对MVA的预测价值。结果在急性发作时,MVA组校正的QT间期离散度(c QTd)、校正的T波峰到T波末端的间期(c Tp-e)、T波峰到T波末端的间期/QT间期(Tp-e/QT)、校正的Tp-e离散度(c Tp-ed)、ST段抬高程度(STE)等心电图参数均明显高于VA组(P<0.05);ROC预测结果显示,c Tp-e、c Tp-ed、Tp-e/QT、STE预测VA患者MVA发生的AUC值明显高于c QTd(P<0.05),Tp-e/QT、c Tp-ed明显高于c Tp-e、STE(P<0.05),Tp-e/QT、c Tp-ed比较差异无统计学意义(P>0.05),c Tp-e、STE比较差异无统计学意义(P>0.05);Logistic回归分析显示,c QTd/QT、c Tp-ed、STE与VA患者MVA发生密切相关(P<0.05)。结论心电图检测能够有效预测VA患者MVA的发生,其中Tp-e/QT、c Tp-ed相对稳定且预测价值较高,可作为VA患者MVA发作风险的有效指标。

Objective To investigate the predictive value of electrocardiogram （ECG） test for malignant ventricular arrhythmia （MVA） in patients with variant angina （VA）, and to provide reliable monitoring basis for the occurrence of MVA in VA patients. Methods A total of 90 patients with VA were admitted to our hospital from June, 2013 to June, 2017, and 67 patients with VA were selected to VA group and 23 patients with VA combined with MVA were selected to MVA group. Logistic regression analysis was used to explore the relationship between ECG parameters and MVA. The area under the curve （AUC） of ROC was used to analyze the predictive value of ECG parameters on MVA. Results In the acute episode, cQTd, cTp-e, Tp-e/QT, cTp-ed and STE of MVA group were significantly higher than those of VA group （P 〈 0.05）. The AUC value of cTp-e, cTp-ed, Tp-e/QT and STE were significantly higher than that of cQTd （P 〈 0.05 ）, the AUC value of Tp-e/QT, cTp-ed were significantly higher than those of cTp-e and STE （ P 〈 0.05 ） ; There was no significant difference on the AUC between Tp-e/QT and cTp-ed （ P 〉 0.05 ）, and there was also no significant difference on the AUC between cTp-e and STE （P 〉 0.05）. Logistic regression analysis showed that there was a close correlation between cQTd/QT, cTp-ed, STE and MVA in VA patients （P 〈 0.05）. Conclusion ECG detection can effectively predict MVA in patients with VA. Tp-e/QT and cTp-ed are relatively stable and have higher predictive value, which can be used as a valid indicator of the risk of MVA in patients with VA.