额面P电轴垂直化的临床意义

Clinical Significance of Frontal P-wave Axis Vertical Transformation

目的探讨心电图额面P电轴垂直化的临床意义。方法以2014年1月—2015年6月于上海市静安区中心医院住院的患者为研究对象,选取210例于1周以内完成了12导联心电图、肺功能、超声心动图的患者,先按P电轴<60°和P电轴>60°分组比较;再以肺功能为金标准,把FEV1/FVC%<70%的66例患者作为观察组,选择FEV1/FVC%>70%的66例肺炎患者作为对照组,评价P电轴垂直化对筛查阻塞性通气障碍的价值。结果 P电轴<60°者87例,其中9例(0.103)FEV1/FVC%<70%;P电轴>60°者95例,其中51例(0.537)FEV1/FVC%<70%。2组FEV1/FVC%、FEV1占预计值%、FVC占预计值%的差异均有统计学意义(P<0.05)。观察组的P电轴(71.6±12.6)与对照组(48.5±27.5)相比,差异有统计学意义(t=6.206, P<0.05),而肺动脉高压、肺动脉宽度的差异均无统计学意义(P>0.05)。若以P电轴>60°为选择标准、P电轴<60°为排除标准筛查阻塞性通气障碍,敏感性为0.850,特异性为0.607,阳性预测值为0.699,阴性预测值为0.791;若以P电轴>70°为选择标准、P电轴<60°为排除标准,敏感性为0.800,特异性为0.872,阳性预测值为0.878。P电轴与FEV1/FVC (r=-0.540,P=0.000)、FEV1 (r=-0.301,P=0.000)、FEV1%(r=-0.421,P=0.000)、FVC%(r=-0.164,P=0.017)、PEF%(r=-0.320,P=0.000)的相关性均有统计学意义(P<0.05)。结论额面P电轴垂直化与阻塞性通气障碍相关,可作为慢性阻塞性肺疾病的初步筛查指标,但不能区分慢性阻塞性肺疾病、哮喘和支气管扩张。

Objective To explore the clinical significance of frontal P-wave axis vertical transformation. Methods 210 hospitalized cases undergoing 12 lead electrocardiogram(ECG), echocardiography and pulmonary function test within 1 week were selected and divided into 3 groups: P axis <60°, P axis =60°and P axis >60°, and the features of the cases in the 3 groups were comparatively studied;then, taking lung function as the gold standard, 66 cases with FEV1/FVC%<70% were selected to be observation group and 66 pneumonia cases with FEV1/FVC%>70% to be control group;the value of P-wave vertical transformation in screening obstructive ventilation disorder was evaluated. Results Out of 87 cases with P axis<60°, 9 cases(0.103%)were with FEV1/FVC%<70% while out of 95 cases with P axis>60°, 51 cases(0.537%) were with FEV1/FVC%<70%, there existed a statistical difference in FEV1/FVC%, FEV1 % and FVC% between the 2 groups(P<0.05);the difference in P axis between observation group and control group [(71.6±12.6) vs.(48.5±27.5)] was of statistical significance(t=6.206, P<0.05)while no statistical difference was found in pulmonary hypertension and pulmonary artery width between the 2 groups(P>0.05);taking P axis>60 ° as selection criteria and P axisM<60 ° as exclusion criteria in screening obstructive airway disorders, the sensitivity was 0.850, specificity was 0.607, positive predictive value was 0.699 and negative predictive value was 0.791;taking P axis>70 °as selection criteria and P axis <60 ° as exclusion criteria, the sensitivity was 0.800, specificity was 0.872, positive predictive value was 0.878;the correlation of P axis to FEV1/FVC(r=-0.540, P=0.000), FEV1(r=-0.301, P=0.000), FEV1%(r=-0.421, P=0.000), FVC%(r=-0.164, P=0.017) and PEF%(r=-0.320, P=0.000) was of statistical significance. Conclusions Frontal P-wave axis vertical transformation is of correlation to obstructive ventilation disorder and can be taken as a preliminary indicator in screening chronic obstructive pulmonary disease(COPD) while it fails to draw out a clear distinction among COPD,asthma and branchectasis.