运动平板试验中疑似冠心病患者T波峰-末间期、QT间期变化的临床诊断价值研究

Study on clinical diagnosis value of T peak-end interval and QT interval changes in patients with suspected coronary heart disease during exercise treadmill test

目的研究疑似冠心病患者运动平板试验(TET)中T波峰-末间期(Tp-Te间期)、Q T间期变化的临床诊断价值。方法将本院胸痛中心2019年4月~2020年4月67例因胸痛就诊的患者作为研究对象,均行运动平板试验及冠状动脉造影检查。结果201例疑似冠心病患者中TET阳性111例,阴性90例。冠脉造影结果阳性102例,阴性99例,阳性符合率为82.35%(84/102),阴性符合率为72.73%(72/99)。以冠脉造影结果为金标准分为4组,TET阳性+冠脉阳性组(n=84)、TET阳性+冠脉阴性组(n=27)、TET阴性+冠脉阳性组(n=18)、TET阴性+冠脉阴性组(n=72)。各组运动峰值Tp-Te间期、QT间期均低于运动前,差异有统计学意义(P<0.05)。TET阳性+冠脉阳性组、TET阳性+冠脉阴性组运动峰值QTc间期高于运动前,差异有统计学意义(P<0.05)。TET阴性+冠脉阳性组、TET阴性+冠脉阴性组运动峰值QTc间期与运动前比较差异无统计学意义(P>0.05)。TET阳性+冠脉阳性组、TET阳性+冠脉阴性组Tp-Te间期、QT间期差值小于TET阴性+冠脉阳性组和TET阴性+冠脉阴性组,TET阳性+冠脉阳性组、TET阳性+冠脉阴性组QTc间期差值大于TET阴性+冠脉阳性组和TET阴性+冠脉阴性组,差异有统计学意义(P<0.05)。TET阳性+冠脉阳性组、TET阳性+冠脉阴性组Tp-Te√RR差值与TET阴性+冠脉阳性组和TET阴性+冠脉阴性组差异有统计学意义(P<0.05)。各组Tp-Te/QT、Tp-Te/QTc差值差异无统计学意义(P>0.05)。结论冠心病和非冠心病患者TET中Tp-Te间期、Q T间期变化存在一定的差异,TET结合Tp-Te间期、Q T间期变化可提高对冠心病诊断的准确率。

Objective To study the clinical diagnosis value of T peak-end interval(Tp-Te interval)and QT interval changes in exercise treadmill test(TET)of patients with suspected coronary heart disease.Methods From April 2019 to April 2020,67 patients who were diagnosed with chest pain in our hospital’s chest pain center were treated as subjects.All of them underwent exercise treadmill test and coronary angiography.Results Among 201 patients with suspected coronary heart disease,111 patients were positive for TET and 90 were negative.Coronary angiography results were positive in 102 cases and negative in 99 cases.The positive coincidence rate was82.35%(84/102)and the negative coincidence rate was 72.73%(72/99).The coronary angiography results were divided into 4 groups according to the gold standard,TET positive+coronary positive group(n=84),TET positive+coronary negative group(n=27),TET negative+coronary positive group(n=18),TET negative+coronary negative group(n=72).The peak exercise Tp-Te interval and QT interval of each group were lower than before exercise,and the difference was statistically significant(P<0.05).The peak QTc interval of exercise in TET positive+coronary positive group and TET positive+coronary negative group was higher than before exercise,the difference was statistically significant(P<0.05).There was no statistically significant difference in the peak QTc interval between exercise and before exercise in TET negative+coronary artery positive group and TET negative+coronary artery negative group(P>0.05).The difference of Tp-Te interval and QT interval between TET positive+coronary positive group,TET positive+coronary negative group was less than TET negative+coronary positive group and TET negative+coronary negative group.TET positive+coronary positive group TET-positive and coronary-negative group QTc interval difference was greater than that of the TET-negative and coronary-positive group and the TET-negative and coronary-negative group,the difference was statistically significant(P<0.05).The difference of Tp-Te√RR in TET positive+coronary positive group and TET positive+coronary negative group was statistically significant compared with TET negative+coronary positive group and TET negative+coronary negative group(P<0.05).There was no significant difference in Tp-Te/QT and Tp-Te/QTc differences between the groups(P>0.05).Conclusion There is a certain difference in Tp-Te interval and Q T interval between TET in patients with coronary heart disease and non-coronary heart disease.TET combined with Tp-Te interval and QT interval change can improve the accuracy of coronary heart disease diagnosis.