稳定型与变异型心绞痛患者心电图及冠状动脉造影特点分析

The characteristics of electrocardiogram and coronary angiogram in patients with stable angina pectoris and variant angina pectoris

目的探讨稳定型与变异型心绞痛患者心电图及冠状动脉造影的特点。方法选取2014年8月—2018月6月十堰市人民医院诊治的心绞痛患者78例,所有患者都给予12导联动态心电图与冠状动脉造影检查,记录影像学特征,判断12导联动态心电图的诊断价值。结果78例患者中,冠状动脉造影诊断为稳定型心绞痛58例(稳定组),变异型心绞痛20例(变异组),两组患者的性别、年龄、合并疾病、体重指数、心功能分级、狭窄分级等比较,差异无统计学意义(P>0.05)。变异组的ST-T压低、T波倒置、ST-T压低合并T波倒置等心电图特征与稳定组比较,差异有统计学意义(P<0.05)。变异组的QRS波持续时间高于稳定组(P<0.05)。心电图诊断变异型心绞痛的敏感性与特异性为95.0%和93.1%。Logistic回归分析显示QRS波持续时间、T波倒置、ST-T压低合并T波倒置是冠心病患者易发变异型心绞痛的影响因素(P<0.05)。结论动态心电图鉴别诊断稳定型心绞痛与变异型心绞痛患者具有很好的敏感性与特异性,心电图可作为冠状动脉造影的补充检查手段。

Objective To investigate and analyze the characteristics of electrocardiogram and coronary angiogram in patients with stable angina pectoris and variant angina pectoris.Methods The 78 patients with angina pectoris who were treated in the Department of Cardiology of Shiyan Renmin Hospital from August 2014 to June 2018 were selected.All patients underwent 12-lead dynamic electrocardiography and coronary angiography,and the imaging features were recorded and the diagnostic value was analyzed.Results In the 78 patients,58 of them were diagnosed as stable angina(stable group)and 20 of them were determined as variant angina pectoris(variant group)via coronary angiography.There was no difference in gender,age,comorbidities,body mass index,cardiac function grading,or grading of coronary stenosis between the the two groups(P>0.05).The electrocardiogram features including ST-segment depression,T-wave inversion,and ST-segment depression with T-wave inversion were significantly different between the stable group and the variant group(P<0.05).The duration of QRS wave in the variant group was significantly higher than that in the stable group(P<0.05).The sensitivity and specificity of electrocardiographic diagnosis for variant angina pectoris were 95.0%and 93.1%,respectively.Logistic regression analysis showed that QRS duration,T-wave inversion,and ST-segment depression with T-wave inversion were influencing factors for variant angina pectoris(P<0.05).Conclusions Dynamic electrocardiography has a good sensitivity and specificity for differentiating stable angina pectoris from variant angina pectoris.Electrocardiography can be used as a supplementary examination for coronary angiography.