高血压患者心电图ST-T改变对冠心病诊断的指导价值研究

A Survey of Electrocardiogram ST-T Changes on the Diagnosis of Coronary Heart Disease in Hypertension Patients

目的分析高血压患者的心电图中ST-T变化对诊断冠心病的指导价值。方法回顾性分析2020年10月至2022年10月濮阳市妇幼保健院收治的86例高血压伴胸痛患者的临床资料,入院后均予以心电图检查,后结合心电图的ST-T改变情况分成ST-T段动态改变组(50例)和无ST-T段动态改变组(36例),将冠脉造影结果当作金标准,比较两组临床资料、冠心病阳性率情况,并统计冠心病阳性患者心电图ST-T段变化类型及心肌缺血发作时间,分析高血压患者心电图中ST-T变化发生率和冠心病发生率的相关性。结果两组患者性别及年龄比较,差异无统计学意义(P>0.05);两组患者收缩压、舒张压、体重指数、心功能分级、空腹血糖(FPG)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及心率比较,差异有统计学意义(P<0.05)。ST-T段动态改变组冠心病阳性率(68.00%)高于无ST-T段动态改变组(19.44%),差异有统计学意义(P<0.05)。ST-T段动态改变组确诊为冠心病的34例患者中,出现心肌缺血时能发现ST-T段变化,其中ST段压低24例,ST段抬高10例。ST-T段动态改变组确诊为冠心病的34例患者中,总共检出缺血ST段改变156次,包括无症状心肌缺血140次,占比是89.74%,且这类心肌缺血常出现在休息或者日常轻度活动期间,很少出现在剧烈运动期间。28例患者心电图检查中未观察到心绞痛症状,占比是82.35%。心肌缺血发作时间多集中在22:00至6:00,占比是69.23%;其次是12:00至21:59,占比是20.51%;最后是6:01至11:59,占比是10.26%。相关性分析发现,高血压患者心电图中ST-T变化发生率和冠心病发生率之间为正相关关系,差异有统计学意义(r=0.698,P<0.05)。结论高血压患者心电图中ST-T变化对诊断冠心病有着重要指导价值,能作为冠心病诊断中的参考依据。

Objective To study the clinical value of electrocardiogram ST-T changes on the diagnosis of coronary heart disease in hypertension patients.Methods The clinical data of 86 patients with hypertension and chest pain admitted to Puyang Maternal and Child Health Hospital from October 2020 to October 2022 were retrospectively analyzed.All patients were examined by electrocardiogram after admission.According to the ST-T changes of electrocardiogram,they were divided into ST-T segment dynamic change group(50 cases)and non-ST-T segment dynamic change group(36 cases).The results of coronary angiography were used as the gold standard,and the clinical data and the positive rate of coronary heart disease were compared between the two groups.The types of electrocardiogram ST-T segment changes and the time of myocardial ischemia in patients with positive coronary heart disease were counted.The correlation between the incidence of ST-T changes in electrocardiogram and the incidence of coronary heart disease in patients with hypertension was analyzed.Results The gender and age between groups were not significantly different(P>0.05);But there were significant between-group differences about the systolic blood pressure,diastolic blood pressure,body mass index,cardiac function classification,fasting plasma glucose(FPG),triglyceride(TG),high density lipoprotein-cholesterol(HDL-C)and heart rates(P<0.05);The positive detection rates of coronary heart disease in ST-T dynamic change group(68.00%)were higher than ST-T unchanged group(19.44%),with significant difference(P<0.05);ST-T segment changes were found when myocardial ischemia occurred in 34 patients with coronary heart disease in the ST-T dynamic change group,including 24 patients with ST-segment depression and 10 patients with ST-segment elevation.A total of 156 ischemic ST-segment changes were detected in 34 patients with coronary heart disease in the ST-T dynamic change group,including 140 asymptomatic myocardial ischemia,accounting for 89.74%.Such myocardial ischemia often occurred at rest or during mild daily activities,and rarely occurred during strenuous exercise.Twenty-eight patients(82.35%)did not have angina symptoms in the ECG examination.The onset time of myocardial ischemia was mainly from 22:00 to 6:00,accounting for 69.23%.Followed by 12:00 to 21:59,accounting for 20.51%;Finally,6:01 to 11:59,accounting for 10.26%.Correlation analysis showed that there was a positive correlation between the incidence of ST-T changes and the incidence of coronary heart disease in patients with hypertension,the difference was statistically significant(r=0.698,P<0.05).Conclusions The ST-T changes in ECG of hypertensive patients have important guiding value in the diagnosis of coronary heart disease,and can be used as a reference for the diagnosis of coronary heart disease.