心电图和超声心动图诊断左心室肥大一致性分析
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摘要
目的对比心电图和超声心动图诊断左心室肥大的一致性,以评价Sokolow-Lyon、Romhilt-Estes score两种心电图诊断标准的优势。方法采用随机抽样的方法抽取2016年1月—2018年10月在本院接受治疗的34～94岁原发性高血压患者231例作为研究对象。采集入选者的心电图和超声心动图,采集心电图各类异常指标,包括QRS时限、RV5电压、QRS电轴等。以超声心动图结果作为金标准,采用Kappa系数分别对两种检查结果进行一致性检验,并分别计算心电图两种诊断方法的敏感度、特异度、阳性预测值和阴性预测值。结果 Sokolow-Lyon组和Romhilt-Estes score组的Kappa系数分别为0.559和0.701,敏感度分别为55.56%、77.78%,特异度分别为95.16%、93.55%,阳性预测值分别为73.53%、74.47%,阴性预测值分别为89.85%、94.57%。结论相比Sokolow-Lyon诊断标准,Romhilt-Estes score诊断左心室肥大的结果更接近超声心动图,更能体现心电图筛查左心室肥大的价值。
Objective By comparing the consistency of electrocardiogram and echocardiography in diagnosis of left ventricular hypertrophy, we evaluated the advantages of diagnosis of Sokolow-Lyon and Romhilt-Estes score. Methods 231 patients aged 34～94 with essential hypertension who were treated in Guangzhou first people' hospital from January 2016 to October 2018 were selected by random sampling. The electrocardiogram and echocardiography were collected in selected patients, and various abnormal electrocardiogram indicators were collected, including QRS time limit, RV5 voltage, ECG axis degree. The echocardiography was used as the gold standard for the diagnosis of left ventricular hypertrophy. The consistency of the two results was checked by using Kappa coefficient. At the same time, the sensitivity, specificity, positive predictive value and negative predictive value of Sokolow-Lyon and Romhilt-Estes score in diagnosis of left ventricular hypertrophy were compared. Results Kappa coefficients of Sokolow-Lyon group and Romhilt-Estes score group were 0.559 and 0.701.The sensitivity and specificity were 55.56%, 77.78% and 95.16%, 93.55% respectively. Positive predictions were 73.53% and 74.47% respectively, while negative predictions were 89.85% and 94.57% respectively. Conclusion Compared with the Sokolow-Lyon, Romhilt-Estes score was closer to echocardiography in diagnosis of left ventricular hypertrophy. And it indicates that electrocardiogram as a screening method for left ventricular hypertrophy is more prospective.
Objective By comparing the consistency of electrocardiogram and echocardiography in diagnosis of left ventricular hypertrophy, we evaluated the advantages of diagnosis of Sokolow-Lyon and Romhilt-Estes score. Methods 231 patients aged 34～94 with essential hypertension who were treated in Guangzhou first people' hospital from January 2016 to October 2018 were selected by random sampling. The electrocardiogram and echocardiography were collected in selected patients, and various abnormal electrocardiogram indicators were collected, including QRS time limit, RV5 voltage, ECG axis degree. The echocardiography was used as the gold standard for the diagnosis of left ventricular hypertrophy. The consistency of the two results was checked by using Kappa coefficient. At the same time, the sensitivity, specificity, positive predictive value and negative predictive value of Sokolow-Lyon and Romhilt-Estes score in diagnosis of left ventricular hypertrophy were compared. Results Kappa coefficients of Sokolow-Lyon group and Romhilt-Estes score group were 0.559 and 0.701.The sensitivity and specificity were 55.56%, 77.78% and 95.16%, 93.55% respectively. Positive predictions were 73.53% and 74.47% respectively, while negative predictions were 89.85% and 94.57% respectively. Conclusion Compared with the Sokolow-Lyon, Romhilt-Estes score was closer to echocardiography in diagnosis of left ventricular hypertrophy. And it indicates that electrocardiogram as a screening method for left ventricular hypertrophy is more prospective.
引文
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[16] 林宏海,蔡仕锴,杨心广,等.尿毒症血透患者心电图PtfVl改变与心功能关系研究[J].现代医院,2018,18(2):240-242.
[2] LEWINGTON S,LACEY B,CLARKE R,et al.The burden of hypertension and associated risk for cardiovascular mortality in China[J].JAMA Intern Med,2016,176(4):524-532.
[3] PADWAL R S,BIENEKK A,MCALISTER F A,et al.Epidemiology of hypertension in Canada:an update[J].Can J Cardiol,2016,32(5):687- 694.
[4] 邓群.我国高血压的空间分布研究[J].中央民族大学学报(自然科学版),2015,24(3):59- 63.
[5] 蒋雪丽,王晋泉,李艳丽,等.不同心电图指标对左心结构异常的诊断价值及其与左心室舒张功能的关系[J].中华高血压杂志,2018,26(6):541-545.
[6] 万学红,卢雪峰.诊断学[M].9版.北京:人民卫生出版社,2018:493- 497.
[7] BUCHNER S,DEBL K,HAIMERL J,et al.Electrocardiographic diagnosis of left ventricular hypertrophy in aortric valve disease:Evaluation of ECG criteria by cardiovascular magnetic resonance [J].Cardiovasc Magn Reson,2009,11(1):18.
[8] 陈小妹,陈孜瑾,马晓波,等.维持性血液透析患者左心室肥厚进展情况和相关危险因素分析[J].上海交通大学学报(医学版),2018,38(5):505-509.
[9] LANDIS J R,KOCH G C.The measurement of observer agreement for Gategorical data[J].Biometrics,1977(33):159-174.
[10] 万学红,卢雪峰.诊断学[M].9版.北京:人民卫生出版社,2018,485- 490.
[11] 蒋雄京.高血压与冠心病[J].中国循环杂志,2012,27(3):168-169.
[12] 杨晨,郭志荣,胡晓抒,等.血压控制与糖尿病发病关系的前瞻性研究[J].中华流行病学杂志,2010,31(3):260-263.
[13] 赵建华.高血压的心脏并发症[J].现代中西医结合杂志,2003,12(22):2500-2501.
[14] 于靖,王湛,扬春生,等.左心室肥厚心电图诊断标准分析[J].中国循环杂志,2004,19(1):28-30.
[15] 梁荣喜,林礼务,薛恩生,等.超声检查质量控制现状分析及对策建议[J].当代医学,2018,12(24):134-136.
[16] 林宏海,蔡仕锴,杨心广,等.尿毒症血透患者心电图PtfVl改变与心功能关系研究[J].现代医院,2018,18(2):240-242.