不同性别肺动脉高压患者心电图特征分析

Analysis of the characteristics of electrocardiogram in patients of different genders with pulmonary hypertension

目的分析肺动脉高压（PH）患者的心电图特征，探讨不同性别PH患者心电图参数与肺血管阻力（PVR）、平均肺动脉压力（mPAP）和心脏指数的相关性。方法回顾性分析2015年8月至2017年10月就诊于广州医科大学附属第一医院呼吸科共101例行右心导管检查确诊PH的患者，排除肺动脉压力正常、临床资料不全及重复检查者。根据性别分组，其中男性组53例，年龄16～87岁，平均（56±14）岁；女性组48例，年龄17～85岁，平均（52±17）岁，两组问年龄差异无统计学意义（P=0．287）。收集心电图各项参数结果及右心导管结果，分析不同性别患者心电图特征及与肺血管阻力、平均肺动脉压力、心脏指数的相关性。结果在所有PH患者中，男性组QRS电轴时限为（110±16）ms，与女性组[（99±18）ms]比较差异有统计学意义（P〈0．001），男性组V5导联S波幅[（1．3±1．4）mv]明显高于女性组[（0．6±0．7）mv]，差异有统计学意义（P〈0．001）。心率校正的QT间期、QRS电轴、Ⅰ导联S波幅、V1导联S和R波幅，V1导联R／S比值、V5导联S波幅与PVR均有相关性，其中V1导联S波幅呈负相关（r=-0．441，P〈0．001）。男性组患者V1导联R／S比值、V5导联S波幅与PVR无相关性。女性组QT间期、V1导联R波幅、Vl导联R／S比值与PVR无相关性。所有患者Ⅱ导联P波时限，QRS电轴、Ⅰ导联S波幅、V1导联S波、R波幅，V5导联S波幅、QT问期、V1导联R／S比值与平均肺动脉压力均有相关性（均P〈0．05）。男性组与QT间期、Ⅱ导联P波时限、V5导联s波幅无相关性（均P〉0．05）。而女性组平均肺动脉压力仅与V1导联S波、R波幅、Ⅰ导联S波幅、V5导联S波幅相关（均P〈0．05）。心脏指数与Vl导联S波幅呈正相关（r=0．34，P〈0．001），与QRS电轴呈负相关（r=-0．219，P=0．04）；男性组心脏指数与QRS电轴无相关性（P=0．073），而与心率校正的QT间期呈负相关（r=-0．296，P=0．044）。结论肺动脉高压患者心电图中QRS时限、V5导联S波幅有性别差异，QRS电轴和V1导联S波幅与心脏指数有相关性。不同性别肺动脉高压患者的心电图与肺血管阻力、平均肺动脉压力、心脏指数的相关性存在差异。

Objective To analyze the characteristics of ECG in patients with pulmonary hypertension（PH） and explore their correlation with pulmonary vascular resistance （PVR） , mean pulmonary arterial hypertension （mPAP） and cardiac index （CI）. Methods A total of 186 patients with fight heart catheterization were enrolled in the Department of Respiratory of the First Affiliated Hospital of Guangzhou Medical University from August 2015 to October 2017. Patients with normal pulmonary artery pressure, incomplete clinical data and repeated examinations were excluded and there were 101 patients with pulmonary hypertension included. The results of ECG parameters and right heart catheterization were collected to analyze the ECG characteristics of patients with different genders and their correlation with PVR, mPAP and CI. Results Among all PH patients, the duration of QRS axial in male group was significantly longer than that of the female group [ （ 110. 38 ± 15. 829） vs. （98.63 ± 18. 041 ） ms, P 〈0. 0011 , and the S wave amplitude in V5 was significantly higher compared to female group [ （ 1. 304 ± 1. 356） vs. （0. 648 ± 0. 663） mv, P 〈0. 001 ]. Their heart rate-corrected QT interval （QTC）, QRS axis, S wave amplitude in Ⅰ , S and R wave amplitude in V1, R/S ratio in V1, S wave amplitude VS, all had a correlation with their PVR and the S wave amplitude in V1 was negatively correlated with PVR （r = -0. 441, P 〈 0. 001 ）. In the male group, PVR was not correlated with R/S ratio in V1 and S wave amplitude in VS. While PVR in the female group was significantly correlated with QTC, R wave amplitude in V1, R / S ratio in V1. In all PH patients, their P wave duration in Ⅱ , QRS axis and S wave amplitude in Ⅰ , S wave and R wave amplitude in V1 , S wave amplitude in VS, QTC, R/S ratio in V1, all had correlations with mPAP （P 〈 0. 05 ）. In male group, mPAP was not correlated with QTC, P wave duration in Ⅱ , and the S wave amplitude in V5 （ P 〉 0. 05 ）. The mPAP in the female group was only related to the S wave and R wave amplitude in V1, and S amplitude in I and S wave amplitude in V5 （P 〈 0. 05 ）. The CI was positively correlated with the S wave amplitude in V1 （r = 0. 34, P 〈 0. 001 ）, and negatively correlated with the QRS axis （r = -0. 219, P = 0.04）; CI in male group was not correlated with QRS axis （P = 0. 073 ）, but correlated with QTC （r = -0. 296, P = 0. 044）. Conclusion There were gender differences in QRS duration and S wave amplitude in V5 in patients with pulmonary hypertension. The QRS axis and the S wave amplitude in V1 were related to the heart index. There was a difference in the correlation between ECG and PVR, mPAP and CI in patients of different genders with pulmonary hypertension.