【摘要】 目的评价平板运动试验QTc间期频率适应性变化对冠心病及早期冠状动脉病变的诊断价值。方法选择新疆医科大学第一附属医院先后行平板运动试验和冠状动脉造影的148例患者,根据冠状动脉造影结果,以频率适应性QTc间期(RAQTc)延长(≥420 ms)为阳性判定标准,进行回顾性病例对照研究。结果 (1)运动中,CAG阳性和CAG阴性两组的QT间期变化不同;(2)RAQTc延长诊断冠心病的敏感性、特异性、准确性、阳性预测值,均高于ST段改变标准;(3)两指标(RAQTc延长和ST段改变)联用可提高冠心病诊断的准确性;(4)经Spearman秩相关分析显示,RAQTc与冠状动脉病变程度呈正相关,有统计学显著差异(r=0.51,P<0.05);(5)与无冠状动脉病变组比较,冠状动脉病变<50%组的RAQTc变化无统计学差异。结论平板运动试验中RAQTc延长可作为诊断冠心病的一个参考指标。早期冠状动脉病变患者运动中QTc间期的频率适应性尚可,RAQTc无明显延长。更多还原

【Abstract】 Objective To assess the value of rate adaptable QT prolongation in treadmill exercise testing(TET) for diagnosing coronary heart disease(CHD).Methods TET was carried on 148 patients with chest pain before coronary artery angiography(CAG).The retrospective case-control study was performed.The medical history of patients,the ST segments,the QT intervals were measured during TET procedure and compared with those results of CAG.RAQTc was more than 420 ms during TET defined as RAQT prolongation(RAQTp).Results(1)QT intervals significantly increased in patients with CHD than patients without;(2)By Spearman rank correlation analysis,compared with control group,the RAQTs in patients with lesion of coronary artery<50% groups is normal.While the positive correlation presents in patients with lesion of coronary artery>50% groups,the more the severe of lesions in coronary artery,the more prolongation of RAQT was detected(r=0.51,P<0.05);(3)The sensitivity and specificity of ST-segment for diagnosing CHD were 75% and 58.55% respectively.Significant higher sensitivity(80%)and specificity(69.12%)were achieved by using RAQTp for diagnosing CHD(P<0.05).Improving further in sensitivity(77.50%)and specificity(64.71%)for diagnosing CHD was not found by combining ST-segment with RAQTp from TET.Conclusions We conclude that RAQTp is more sensitive than ST-segment for detection of coronary heart abnormality,and RAQTp can predict the degree of stenotic lesions in the coronary arteries,while further study is needed in evaluating its value in detecting early stage stenotic lesion of coronary artery.更多还原