MD  >> Vol. 7 No. 2 (June 2017)

    常规心电图与冠脉造影诊断缺血性心脏病的一致性分析
    Consistency Analysis of Coronary Arteriography and Electrocardiogram in Ischemic Heart Disease

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作者:  

马龙,曾娟,刘晓丽,李丽芝:华北石油管理局总医院,河北 任丘;
贺庆:四川大学华西医院,四川 成都

关键词:
心电图冠脉造影缺血性心脏病一致性诊断Electrocardiogram Arteriography Ischemic Heart Disease Consistency Diagnosis

摘要:

目的:评价十二导联常规心电图对冠脉缺血性心脏病的诊断与冠脉造影检查结果的一致性。方法:收集、对比2011年~2015年期间华北石油管理局总医院心内科109例行冠脉造影检查住院患者的术前常规十二导联心电图与其冠脉造影结果。将术前常规心电图结果按其具体表现分为:完全正常心电图;非特异性异常心电图(包括各种心律失常,非特异性ST-T改变)以及特异性改变心电图(包括异常Q波,典型ST抬高或压低,明显T波改变)。冠脉造影结果按照冠脉斑块阻塞程度也分为三组:冠脉斑块阻塞小于50%;冠脉斑块阻塞50%~75%;冠脉斑块阻塞大于75%。对数据进行汇总,并做一致性分析统计。结果:109例中,常规心电图为完全正常窦性心律的有17例,非特异性异常心电图(包括心律失常11例,非特异性ST-T改变9例)20例,特异性改变心电图(包括异常Q波10例,ST-T改变40例,单纯ST压低12例,单纯T波倒置10例)72例;冠脉造影结果无斑块及阻塞小于50%共19例,冠脉斑块阻塞50%~75%的共11例,冠脉斑块阻塞大于75%的共79例。经分析后得出,两种检查结果有相关性(卡方 = 40.7520,P = 0.0000),可以用Kappa指数描述其一致性。Kappa指数 = 0.286195,说明此两种检查的一致性较差。结论:常规十二导联心电图是诊断冠脉缺血性心脏病的重要方法,但由于受采集时机等因素影响,其表现与实际冠脉病变程度一致性较差,不能单纯依此作为判断冠状动脉狭窄程度的依据,需要通过运动实验,24小时动态心电监测等检查来提高检测的敏感度和准确率。Aims: To analyze the consistency between coronary arteriography and electrocardiogram in ischemic heart disease. Methods: Between 2011 and 2015, 109 patients who received both arteriography and electrocardiogram in Cardiology Department, Huabei Petroleum General Hospital, were registered. We divided arteriography results into 3 groups by the degree of stenosis of coronary artery as <50%; 50% - 75%; >75%. The similar division was made in electrocardiogram results into 3 groups as normal, nonspecific abnormal and specific abnormal too. Results: In electrocardiogram teams, 17 patients were enrolled in normal group; 20 were nonspecific abnormal and the last 72 were specific abnormal. When it came to the arteriography teams, 19 were the degree of stenosis of coronary artery < 50%; 11 were 50% - 75%; 79 were >75%. Kaplan-Meier analyses revealed that the very two methods’ results did have consistency (Kappa = 40.7520, p = 0.0000). However the Kappa index was 0.286195. That means the correlation between the two methods was poor. Conclusion: The electrocardiogram was important in detecting ischemic heart disease. However, under influence of many factors including the collecting time, the results of electrocardiogram was poor correlated with the real condition of coronary artery. We cannot simply diagnosis ischemic heart disease by the abnormal electrocardiogram alone. Combining with exercise test and 24 hour Holter monitoring, electrocardiogram can be more sensitive and accurate.



文章引用:
马龙, 曾娟, 刘晓丽, 李丽芝, 贺庆. 常规心电图与冠脉造影诊断缺血性心脏病的一致性分析[J]. 医学诊断, 2017, 7(2): 17-21. https://doi.org/10.12677/MD.2017.72004

参考文献

[1] Gramer, B.M., Muenzel, D., Leber, V., et al. (2012) Impact of Iterative Reconstruction on CNR and SNR in Dynamic Myocardial Perfusion Imaging in an Animal Model. European Radiology, 22, 2654-2661.
https://doi.org/10.1007/s00330-012-2525-z
[2] Wang, Y., Qin, L., Shi, X., et al. (2012) Adenosin-Stress Dynamic Myocardial Perfusion Imaging with Second-Gene- ration Dual-Source CT: Comparison with Conventional Catheter Coronary Angiography and SPECT Nuclear Myocardial Perfusion Imaging. American Journal of Roentgenology, 198, 521-529.
https://doi.org/10.2214/AJR.11.7830
[3] 尹乐芬. 24小时心电图与常规心电图诊断冠心病心律失常的比较[J]. 中国保健营养, 2014, 24(2): 767-768.
[4] 李俊峡, 崔俊玉. 心电图在冠心病诊断中的价值[J]. 临床误诊误治, 2007, 20(8): 1-4.
[5] 龚璇, 唐学杰, 韩贞普. 运动平板心电图阳性与冠脉造影价值的比较研究[J]. 实用心脑肺血管病杂志, 2011, 19(11): 1911-1912.
[6] 朱小玲. 2364例运动平板试验结果及诱发心律失常情况分析[J]. 健康之路, 2013, 12(8): 16-17.
[7] 杨文珍. 冠心病患者在运动平板试验中诱发心律失常的临床意义[J]. 哈尔滨医药, 2012, 32(1): 21.
[8] 尹岚. 运动平板试验中室性心律失常的发生与冠心病的相关性研究[J]. 临床内科杂志, 2016, 33(11): 770-772.
[9] 黄素华, 卢青英, 邹冠蓉. 运动试验致晕厥原因分析[J]. 心血管康复医学杂志, 2006, 15(5): 503-504.
[10] 郭继鸿. 非ST段抬高急性冠脉综合征的溯源[J]. 心电与循环, 32(5): 352-354.
[11] 钟德福, 李莉. 24h心电图与常规心电图诊断冠心病心律失常的临床效果[J]. 中国当代医药, 2016, 23(25): 32-34.