中国健康人群心电图Q波参数正常范围的调查

Normal limits of Q-wave measurements in Chinese subjects

目的 :调查中国健康人群 12导联心电图Q波参数的正常范围 ,评估传统的Q波标准。方法 :采集5 36 0例 (男 36 14例 ,女 174 6例 )健康人心电图资料 ,并按性别分为 5个年龄组 ,计算各年龄组Q波时限、振幅和Q/R比例的中位数和正常上限值 ,以及各导联上QS波类型的发生率。结果 :男性Q波时限稍长于女性 ,性别差异为 2～ 5ms。Q波时限正常范围在Ⅰ、V5和V6导联≤ 2 5ms ,在aVL导联≤ 4 5ms ;在下壁导联中 ,Q波时限正常范围在Ⅲ导联 <4 0ms,在Ⅱ和aVF导联 <30ms。各导联的Q波振幅正常上限值在不同年龄组间显示较大的变异。Q/R比例的正常上限值在Ⅰ、Ⅱ导联一般 <2 5 % ,而在V5和V6导联 <15 % ;aVL、Ⅲ和aVF导联的Q/R比例正常上限值在不同年龄组间显示较大的变异。QS波类型在V1导联的发生率为 1.5 % (80 / 5 36 0 ) ,在V2 导联的发生率为 0 .2 % (9/ 5 36 0 )。除Ⅲ和aVL导联外 ,传统的Q波标准的诊断特异性可达到 99%～ 10 0 %。结论 :Q波参数的正常值标准有明显的导联依赖性。适当调整传统的Q波标准 。

Objective:To assess normal criteria for Q wave and limits of Q wave measurements.Method: The study population was composed of 5360 (3614 men and 1746 women) healthy individuals. According to ages, they were invided into five groups: 18～29, 30～39, 40～49, 50～59 and ≥60 years. The standard 12 lead electrocardiogram (ECG) of each individual was recorded and Q wave duration, amplitude and Q/R ratio were measured with a well validated computer program. The median, upper normal limits of various Q wave measurements were calculated for different age groups. The prevalence of QS pattern was also examined in each of 12 leads.Results:The upper normal limit of Q wave duration was slightly longer in men than in women, with a sex difference of 2～5 ms. The normal limit of Q wave duration was ≤25 ms for leads I, V 5 and V 6, and ≤45 ms for lead aVL. In inferior leads, Q wave duration was <40 ms for lead Ⅲ, and <30 ms for leads Ⅱ and aVF. The upper limits of Q wave amplitude vary considerably over age groups for all leads. The normal limits of Q/R ratio was <25% for leads Ⅰ and Ⅱ, and <15% for leads V 5 and V 6. Q/R ratio in aVL, Ⅲ and aVF leads, however, showed larger dispersion between age groups. 1.5 % (80/5 360) of the subjects had a QS pattern in lead V 1; QS pattern seldom occur in lead V 2 . The specificity of traditional criteria for abnormal Q wave was 99%～100%, except for lead Ⅲ and aVL.Conclusion:This study suggests that normal Q wave criteria should be made lead dependent, adjustment of some criteria thresholds may further improve the accuracy of ECG diagnosis.