心电图Peguero-Lo Presti电压标准诊断成人高血压相关性左室肥厚的价值

The value of ECG Peguero-Lo Presti voltage standard in the diagnosis of hypertension associated left ventricular hypertrophy in adults

目的在诊断成人高血压相关性左室肥厚的心电图检查标准中分析评价Peguero-Lo Presti电压标准的优势和价值。方法选择2016年9月—2017年9月在温州医科大学附属二院就诊的高血压患者138例,以超声心动图为“金”标准,评价心电图传统Sokolow电压标准,Cornell电压标准和Peguero-Lo Presti电压标准诊断左心室肥厚(LVH)的准确性,灵敏度和特异性。结果3种电压标准诊断LVH的准确性为Peguero-Lo Presti标准最高,为77.54%;特异性是Cornell标准最高,为88.33%,而灵敏度是Peguero-Lo Presti指标最高,为82.05%。χ^2检验示Peguero-Lo Presti标准具有最好的准确性和灵敏度(均P<0.05),而在特异性上,虽Cornell标准最高,但3种标准诊断特异性相差不大,差异无统计学意义(P=0.068)。Kappa检验显示3种心电图诊断标准,Peguero-Lo Presti标准具有最高的Kappa值为0.540,与金标准一致性最好。应用ROC曲线评价3种心电图标准对诊断LVH的预测价值中,Peguero-Lo Presti标准有最高的AUC值达0.886,对LVH的诊断评价最有意义。结论综合各项指标,Peguero-Lo Presti电压标准诊断LVH最具有价值,且计算简便,值得临床应用和推广。

Objective To analyze and evaluate the advantage and value of the Peguero-Lo Presti voltage standard in the electrocardiographic criteria for the diagnosis of hypertension associated left ventricular hypertrophy(LVH)in adults.Methods Total 138 hypertensive patients were selected from the Second Affiliated Hospital of Wenzhou Medical Univer-sity from September 2016 to September 2017 to evaluate the accuracy,sensitivity and specificity of traditional Sokolow voltage standard,Cornell voltage standard and Peguero-Lo Presti voltage standard in the diagnosis of LVH based on the echocardiography as the"gold"standard.Results The accuracy of three voltage standards for LVH diagnosis was the highest in Peguero-Lo Presti standard(77.54%),the specificity was the highest in Cornell standard(88.33%),and the sensitivity was the highest in Peguero-Lo Presti standard(82.05%).The Chi square test showed that Peguero-Lo Presti standard had the best accuracy and sensitivity(P<0.05),the difference was statistically significant,but in the specificity,although Cornell standard was the highest,the three standards had no significant difference in diagnosis speci-ficity(P=0.068).The Kappa test showed that the highest kappa value of Peguero-Lo Presti standard was 0.540,which was consistent with the gold standard.The AUC value of Peguero-Lo Presti standard was 0.886,which was the most sig-nificant for the diagnosis of LVH.Conclusion According to all the indexes,Peguero-Lo Presti voltage standard is the most valuable and simple in diagnosis of LVH,which is worthy of clinical application and promotion.