心电图持续性ST段压低对冠心病的诊断价值
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摘要
研究目的
分析静息心电图持续性ST段压低与冠状动脉病变以及不同冠脉病变程度的关系,持续性ST段压低与心脏结构改变的关系。
方法
对我院心内科2007年1月到2008年9月有胸闷、胸痛等症状拟诊断为冠心病的住院患者进行回顾性分析,所有研究对象均行标准12导联静息心电图、超声心动图检查和选择性冠状动脉造影术。
统计各支冠脉病变的发生情况,不同程度冠脉病变时心电图持续性ST段压低的发生情况,分析心电图对冠心病诊断的敏感性和特异性,探讨心电图对冠心病的诊断价值,以及其与冠脉病变程度的关系。统计非冠心病组中其他疾病时心电图ST段压低的发生情况,心脏结构改变与心电图改变的符合情况,以及这种符合情况与冠脉病变程度的关系,以更进一步说明心电图ST段压低对冠心病的诊断价值,为临床诊断提供依据。
结果
按照严格的入选标准和排除标准共选出患者430例,其中有男性患者277人,女性患者153人。其中静息心电图阳性组有179例,阴性组251例;冠脉造影阳性组212例,阴性组218例。心电图阳性组中,冠心病的发病率为37.4%,冠心病组中心电图ST段压低的发生率为31.6%。在218例冠脉造影阴性的患者中,有98例为高血压病,其中58例心电图出现ST段压低。在心电图阳性组中,有75.5%的患者出现心脏结构的改变;而在冠心病组中,心脏结构正常的患者只有11.7%出现心电图阳性改变,另外的88.3%心电图都没有出现ST段的压低。对不同冠脉病变程度组的患者进行分析,表明冠脉病变程度与持续性ST段压低及心脏结构的改变均无明显相关。
结论
本研究表明,冠脉造影阳性的患者中只有约三分之一的出现静息心电图持续性ST段压低,且在不同的冠脉病变组中,持续性ST段压低的比率并没有明显差别;而在静息心电图阳性组中,只有少部分为冠心病,而这部分冠心病患者还多伴有心脏结构的异常。且还发现心脏结构正常的患者中,只有极少部分出现心电图ST段压低,而心电图异常的患者中,大部分都伴有心脏结构的改变。可见,静息心电图对冠心病的诊断价值并不高,临床依据持续性ST段压低诊断冠心病时应慎重。
Objective:To analyze the relationship of persistent resting ECG ST-segment depression and coronary artery disease,as well as the extent of coronary artery disease,the relation of persistent resting ECG ST-segment depression and organic heart disease.
Methods:I choosed patients who were diagnosed as coronary artery disease initially for chest pain in January 2007 to September 2008 in our hospital,all patients underwent standard 12-lead resting ECG,cardiac ultrasound dynamic examination and selectively coronary angiography.
To statistic on the branch of the occurrence of coronary artery disease,statistic the incidence rate of persistent ECG ST-segment depression in patients with the different extent of coronary artery disease,to analyze the sensitivity and specificity of ECG diagnosis of coronary heart disease,explore the the importance of ECG in diagnosing the coronary artery disease,as well as the relationgship between the diagnosis and the different extent of coronary artery disease.To statistic the the occurrence rate of persistent ST-segment depression in other diseases except coronary artery disease,the relationgship between the changes of cardiac structure and the persistent ECG ST-segment depression,as well as the connection between the relationship and the different extent of coronary artery disease,for further accoutting for the importance of persistent ECG ST-segment depression in diagnosin of coronary artery disease,in order to provide the value of clinical diagnosis.
Results:
There are 430 patients are selected with selection criteria except exclusion criteria,there are 277 men patients,the and 153 women patients.There are 179 patients who are positive on resting ECG,and the others are negative on resting ECG.There are 212 patients who are coronary heart disease,and the others are non-coronary heart disease.The incidence of coronary heart disease for 37.4%in the groups of positive resting ECG,there are 31.6 patients in 100 patients who are persistent ECG ST-segment depression in the groups of coronary heart disease.In 218 cases of patients with negative coronary angiography,98 cases of hypertension,of which 58 cases whose ECG ST segment are depressed.In ECG-positive group,75.5%of patients have cardiac structural changes,and in the group of coronary heart disease,only 11.7%of patients who have nomal cardiac structural are positive in resting ECG,and the other 88.3%of patients are negative in resting ECG.I analyse the patients who have different extent of coronary artery disease,detect that the extent of coronary artery disease with persistent ST-segment depression and cardiac changes in the structure of no significant correlation.
Conclusion:
The results demonstrate that only one third of patients who are coronary heart disease appear persistent resting ECG ST-segment depression,and in the groups of different coronary artery disease,there is no obvious relation between the rate of continuity ST segment depression and and the extent of coronary artery.In other group who have persistent resting ECG ST-segment depression,only a few of patients are coronary artery disease,however,these patients with coronary heart disease more associated with abnormal cardiac structure.And also found in patients with normal cardiac structure,only a few portion appear ECG ST-segment depression,the patients with ECG abnormalities,most of which accompanied by changes in the structure of the heart.So we can see,resting ECG diagnosis of coronary artery disease was not high,we should be careful if we want to take persistent ST-segment depression on resting ECG as electrocardiographic diagnostic criteria of coronary heart disease.
分析静息心电图持续性ST段压低与冠状动脉病变以及不同冠脉病变程度的关系,持续性ST段压低与心脏结构改变的关系。
方法
对我院心内科2007年1月到2008年9月有胸闷、胸痛等症状拟诊断为冠心病的住院患者进行回顾性分析,所有研究对象均行标准12导联静息心电图、超声心动图检查和选择性冠状动脉造影术。
统计各支冠脉病变的发生情况,不同程度冠脉病变时心电图持续性ST段压低的发生情况,分析心电图对冠心病诊断的敏感性和特异性,探讨心电图对冠心病的诊断价值,以及其与冠脉病变程度的关系。统计非冠心病组中其他疾病时心电图ST段压低的发生情况,心脏结构改变与心电图改变的符合情况,以及这种符合情况与冠脉病变程度的关系,以更进一步说明心电图ST段压低对冠心病的诊断价值,为临床诊断提供依据。
结果
按照严格的入选标准和排除标准共选出患者430例,其中有男性患者277人,女性患者153人。其中静息心电图阳性组有179例,阴性组251例;冠脉造影阳性组212例,阴性组218例。心电图阳性组中,冠心病的发病率为37.4%,冠心病组中心电图ST段压低的发生率为31.6%。在218例冠脉造影阴性的患者中,有98例为高血压病,其中58例心电图出现ST段压低。在心电图阳性组中,有75.5%的患者出现心脏结构的改变;而在冠心病组中,心脏结构正常的患者只有11.7%出现心电图阳性改变,另外的88.3%心电图都没有出现ST段的压低。对不同冠脉病变程度组的患者进行分析,表明冠脉病变程度与持续性ST段压低及心脏结构的改变均无明显相关。
结论
本研究表明,冠脉造影阳性的患者中只有约三分之一的出现静息心电图持续性ST段压低,且在不同的冠脉病变组中,持续性ST段压低的比率并没有明显差别;而在静息心电图阳性组中,只有少部分为冠心病,而这部分冠心病患者还多伴有心脏结构的异常。且还发现心脏结构正常的患者中,只有极少部分出现心电图ST段压低,而心电图异常的患者中,大部分都伴有心脏结构的改变。可见,静息心电图对冠心病的诊断价值并不高,临床依据持续性ST段压低诊断冠心病时应慎重。
Objective:To analyze the relationship of persistent resting ECG ST-segment depression and coronary artery disease,as well as the extent of coronary artery disease,the relation of persistent resting ECG ST-segment depression and organic heart disease.
Methods:I choosed patients who were diagnosed as coronary artery disease initially for chest pain in January 2007 to September 2008 in our hospital,all patients underwent standard 12-lead resting ECG,cardiac ultrasound dynamic examination and selectively coronary angiography.
To statistic on the branch of the occurrence of coronary artery disease,statistic the incidence rate of persistent ECG ST-segment depression in patients with the different extent of coronary artery disease,to analyze the sensitivity and specificity of ECG diagnosis of coronary heart disease,explore the the importance of ECG in diagnosing the coronary artery disease,as well as the relationgship between the diagnosis and the different extent of coronary artery disease.To statistic the the occurrence rate of persistent ST-segment depression in other diseases except coronary artery disease,the relationgship between the changes of cardiac structure and the persistent ECG ST-segment depression,as well as the connection between the relationship and the different extent of coronary artery disease,for further accoutting for the importance of persistent ECG ST-segment depression in diagnosin of coronary artery disease,in order to provide the value of clinical diagnosis.
Results:
There are 430 patients are selected with selection criteria except exclusion criteria,there are 277 men patients,the and 153 women patients.There are 179 patients who are positive on resting ECG,and the others are negative on resting ECG.There are 212 patients who are coronary heart disease,and the others are non-coronary heart disease.The incidence of coronary heart disease for 37.4%in the groups of positive resting ECG,there are 31.6 patients in 100 patients who are persistent ECG ST-segment depression in the groups of coronary heart disease.In 218 cases of patients with negative coronary angiography,98 cases of hypertension,of which 58 cases whose ECG ST segment are depressed.In ECG-positive group,75.5%of patients have cardiac structural changes,and in the group of coronary heart disease,only 11.7%of patients who have nomal cardiac structural are positive in resting ECG,and the other 88.3%of patients are negative in resting ECG.I analyse the patients who have different extent of coronary artery disease,detect that the extent of coronary artery disease with persistent ST-segment depression and cardiac changes in the structure of no significant correlation.
Conclusion:
The results demonstrate that only one third of patients who are coronary heart disease appear persistent resting ECG ST-segment depression,and in the groups of different coronary artery disease,there is no obvious relation between the rate of continuity ST segment depression and and the extent of coronary artery.In other group who have persistent resting ECG ST-segment depression,only a few of patients are coronary artery disease,however,these patients with coronary heart disease more associated with abnormal cardiac structure.And also found in patients with normal cardiac structure,only a few portion appear ECG ST-segment depression,the patients with ECG abnormalities,most of which accompanied by changes in the structure of the heart.So we can see,resting ECG diagnosis of coronary artery disease was not high,we should be careful if we want to take persistent ST-segment depression on resting ECG as electrocardiographic diagnostic criteria of coronary heart disease.
引文
[1].郭继宏.动态心电图学.第一版,北京:人民出版社,2003,658-659.
[2].黄大显.现代心电图学[M].第2版.北京:人民军医出版社,1998,105-140.
[3].张凯.冠脉造影对心电图ST-T改变的临床评价.海南医学,2007,18:7.
[4].杨亚荣,卢起松.不典型心纹痛的诊断再探讨.海南医学,2002,13:10.
[5].陈文彬,潘祥林.诊断学.第6版.北京人民卫生出版社,2004.522.
[6].陈晓瑞,刘建华,马金霞.心电图ST-T改变者与冠脉造影的对比研究.实用心电学杂志,2004,27(1):38-39.
[7].陈撷珠.内科学.第四版。北京人民卫生出版社,1996,260.
[8].郭继鸿.慢性冠状动脉供血不足心电图概念的质疑.心电学杂志,2003,22(1):21-27.
[9].林荣,林青.常规静息心电图慢性ST-T改变与冠状动脉病变的临床探讨.临床心电学杂志,2006,15(3):182-183.
[10].钱学贤,胡大一.现代冠心病监护治疗学.第二版.北京:人民军医出版社,2003,38-42.
[11].杨璇,张瑞军.冠状动脉造影为三支或双支病变的心电图临床研究[J].临床心电学杂志,2006,15(3):182-183.
[12].耿黎明.心电图与冠脉造影的对比分析[J].实用心电学杂志,2008,04:270-271.
[13].郭继鸿.动态心电图学.第一版,北京:人民卫生出版社,2003,658-659.
[14].陈秋华.非缺血性S T—T改变特点分析.医学理论与实践.2002,15(4):375-377.
[15].李占全.冠状动脉造影与临床[M].沈阳:辽宁科学技术出版社,2001.187-192.
[16].马菊琴,王晓利,薛莉.心脏X综合征的发病机制及其研究进展.宁夏医学杂志.2009,31(2):181-182.
[1].郭继宏.动态心电图学.第一版,北京:人民出版社,2003,658-659
[2].张凯,冠脉造影对心电图ST-T改变的临床评价,海南医学2007.18:7
[3].杨亚荣,卢起松.不典型心纹痛的诊断再探讨,海南医学2002.13:10.
[4].Antoni Bayes de Luna,MD.Clinical Electrocardiography:A textbook.2 nd updated Edition.Armonk,New York:Futura Publishing Company,Inc.2000,AE-7.
[5].Dzau VJ,Gibbons GH,Cooke JP,et al.VAscullar biology and medicine in1990s:Scopeconcept,potentialandperspective.Circulation,1993,87(3):705-719.
[6].陈秋华.非缺血性S T—T改变特点分析.医学理论与实践.2002,15(4):375-377.
[7].BRANDENBURY R O,CLIFFORD P,EDWARDS W C,et al.Cardiology Fundamentals and Practice[M].Isted Chicago:Year Book Medical Publishers,1987:337.
[8].黄宛.临床心电图学,第5版。人民卫生出版社,1998,79-86
[9].郭继鸿.慢性冠状动脉供血不足心电图概念的质疑.心电学杂志,2003,22(1):21-27.
[10].冯海新.临床心电学及图谱详解.第一版,人民军医出版社,2004,166-167.
[11].Hugenholtz PG,Lees MM,Nadas AS.The scalar electrocardiogram vector cardiogram,and exercise electrocardiogram in the assessment of congenital aorticstenosis.Circulation,1986,26:79.
[12].姜丕桥,姚静,马野.中年女性轻度ST段压低与冠脉造影比较52例分析.中国误诊学杂志,2007,11(7):6635-6636.
[13].王吉耀.内科学[M].北京:人民卫生出版社,2005:257.
[14].黄大显.现代心电图学,第一版.人民军医出版社,1998,98-102.
[15].Kim YN Sousa J ElAtassiR et al Magnitude of ST segment depression during PSVT[J Am Heart J,1991,122(4);1486
[16].黎启华,曾秋棠.持续性ST-T改变对慢性心肌缺血诊断价值的探讨.心电学杂志,2004,23(2):72-73.
[17].林荣,林青.常规静息心电图慢性ST-T改变与冠状动脉病变的临床探讨.临床心电学杂志,2006,15(3):182-183.
[18].张忆湘.持续性ST-T改变64例临床意义分析.实用预防医学,2005,(03)22.
[19].王顺保,高恩民.持续性ST-T改变对慢性冠状动脉供血不足的诊断价值.中国误诊学杂志,2004,04(2):566-567.
[20].尹鲁骅,李金龙,吴云,等.冠状动脉造影评价ST-T改变在冠心病中的诊断价值.社区医学杂志,2006,4(9):6-7.
[21].费超,由倍安.心电图ST—T改变与冠状动脉造影的对比分析.工企医刊,2006,19(1):2-3.
[22].吴敏,师红林,董昆芸.冠状动脉造影与慢性冠状动脉供血不足心电图的分析.中 国医药导报,2008,5(4):46.
[23].陈松,龚亚驰,马根山,等.冠心病病人静息心电图与冠状动脉造影对比研究[J].齐齐哈尔医学院学报,2005,26(9):101321014.
[2].黄大显.现代心电图学[M].第2版.北京:人民军医出版社,1998,105-140.
[3].张凯.冠脉造影对心电图ST-T改变的临床评价.海南医学,2007,18:7.
[4].杨亚荣,卢起松.不典型心纹痛的诊断再探讨.海南医学,2002,13:10.
[5].陈文彬,潘祥林.诊断学.第6版.北京人民卫生出版社,2004.522.
[6].陈晓瑞,刘建华,马金霞.心电图ST-T改变者与冠脉造影的对比研究.实用心电学杂志,2004,27(1):38-39.
[7].陈撷珠.内科学.第四版。北京人民卫生出版社,1996,260.
[8].郭继鸿.慢性冠状动脉供血不足心电图概念的质疑.心电学杂志,2003,22(1):21-27.
[9].林荣,林青.常规静息心电图慢性ST-T改变与冠状动脉病变的临床探讨.临床心电学杂志,2006,15(3):182-183.
[10].钱学贤,胡大一.现代冠心病监护治疗学.第二版.北京:人民军医出版社,2003,38-42.
[11].杨璇,张瑞军.冠状动脉造影为三支或双支病变的心电图临床研究[J].临床心电学杂志,2006,15(3):182-183.
[12].耿黎明.心电图与冠脉造影的对比分析[J].实用心电学杂志,2008,04:270-271.
[13].郭继鸿.动态心电图学.第一版,北京:人民卫生出版社,2003,658-659.
[14].陈秋华.非缺血性S T—T改变特点分析.医学理论与实践.2002,15(4):375-377.
[15].李占全.冠状动脉造影与临床[M].沈阳:辽宁科学技术出版社,2001.187-192.
[16].马菊琴,王晓利,薛莉.心脏X综合征的发病机制及其研究进展.宁夏医学杂志.2009,31(2):181-182.
[1].郭继宏.动态心电图学.第一版,北京:人民出版社,2003,658-659
[2].张凯,冠脉造影对心电图ST-T改变的临床评价,海南医学2007.18:7
[3].杨亚荣,卢起松.不典型心纹痛的诊断再探讨,海南医学2002.13:10.
[4].Antoni Bayes de Luna,MD.Clinical Electrocardiography:A textbook.2 nd updated Edition.Armonk,New York:Futura Publishing Company,Inc.2000,AE-7.
[5].Dzau VJ,Gibbons GH,Cooke JP,et al.VAscullar biology and medicine in1990s:Scopeconcept,potentialandperspective.Circulation,1993,87(3):705-719.
[6].陈秋华.非缺血性S T—T改变特点分析.医学理论与实践.2002,15(4):375-377.
[7].BRANDENBURY R O,CLIFFORD P,EDWARDS W C,et al.Cardiology Fundamentals and Practice[M].Isted Chicago:Year Book Medical Publishers,1987:337.
[8].黄宛.临床心电图学,第5版。人民卫生出版社,1998,79-86
[9].郭继鸿.慢性冠状动脉供血不足心电图概念的质疑.心电学杂志,2003,22(1):21-27.
[10].冯海新.临床心电学及图谱详解.第一版,人民军医出版社,2004,166-167.
[11].Hugenholtz PG,Lees MM,Nadas AS.The scalar electrocardiogram vector cardiogram,and exercise electrocardiogram in the assessment of congenital aorticstenosis.Circulation,1986,26:79.
[12].姜丕桥,姚静,马野.中年女性轻度ST段压低与冠脉造影比较52例分析.中国误诊学杂志,2007,11(7):6635-6636.
[13].王吉耀.内科学[M].北京:人民卫生出版社,2005:257.
[14].黄大显.现代心电图学,第一版.人民军医出版社,1998,98-102.
[15].Kim YN Sousa J ElAtassiR et al Magnitude of ST segment depression during PSVT[J Am Heart J,1991,122(4);1486
[16].黎启华,曾秋棠.持续性ST-T改变对慢性心肌缺血诊断价值的探讨.心电学杂志,2004,23(2):72-73.
[17].林荣,林青.常规静息心电图慢性ST-T改变与冠状动脉病变的临床探讨.临床心电学杂志,2006,15(3):182-183.
[18].张忆湘.持续性ST-T改变64例临床意义分析.实用预防医学,2005,(03)22.
[19].王顺保,高恩民.持续性ST-T改变对慢性冠状动脉供血不足的诊断价值.中国误诊学杂志,2004,04(2):566-567.
[20].尹鲁骅,李金龙,吴云,等.冠状动脉造影评价ST-T改变在冠心病中的诊断价值.社区医学杂志,2006,4(9):6-7.
[21].费超,由倍安.心电图ST—T改变与冠状动脉造影的对比分析.工企医刊,2006,19(1):2-3.
[22].吴敏,师红林,董昆芸.冠状动脉造影与慢性冠状动脉供血不足心电图的分析.中 国医药导报,2008,5(4):46.
[23].陈松,龚亚驰,马根山,等.冠心病病人静息心电图与冠状动脉造影对比研究[J].齐齐哈尔医学院学报,2005,26(9):101321014.