【摘要】 目的研究心电图在青少年心脏抑制型血管迷走性晕厥(VVS-CI)诊断中的应用价值。方法采用回顾性分析方法,研究对象为2018年1月至2020年1月入沧州市中心医院治疗的86例VVS-CI青少年,将其作为VVS-CI组;同时,选取同期入院的86例健康青少年作为研究对象,将其设定为健康组。比较2组基础状态下12导联心电图P波时限及电压,并对其变化特点进行分析。结果与健康组相比,VVS-CI组的P波离散度(Pd)、P波最大时间(max)、P波时间(Pwd)、校正P波离散度(Pcd)、校正P波最大时间(Pcmax)更长,心率更低,差异均有统计学意义(P <0.05); 2组P波电压、P波最小时间(Pmin)、校正P波最小时间(Pcmin)、校正P波时间(Pcwd)比较,差异无统计学意义(P> 0.05)。受试者工作特征曲线分析显示Pcd、Pcmax、Pd、Pmax、Pwd诊断青少年VVS-CI性能较好(P <0.001),其中Pcd的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.858、0.784～0.933、36.36 ms、83.73%、72.09%、3.00、0.23、55.81%,Pcmax的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.676、0.561～0.792、120.89%、46.51%、88.37%、4.00、0.61、34.88%,Pd的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.907、0.849～0.965、27.41 ms、95.35%、69.77%、3.15、0.07、65.17%,Pmax的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.853、0.766～0.940、93.38 ms、76.74%、90.70%、8.25、0.26、67.44%,Pwd的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.731、0.616～0.846、78.48 ms、69.77%、83.72%、4.29、0.36、53.49%。结论 VVS-CI青少年的Pcd、Pcmax、Pd、Pmax、Pwd显著延长,提示心房电活动异常,心电图P波界值可用于诊断青少年VVS-CI。更多还原

【Abstract】 Objective To study the application value of electrocardiogram( ECG) in the diagnosis of cardiac inhibitory vasovagal syncope( VVS-CI) in adolescents. Methods Retrospective analysis was performed on 86 adolescents with VVS-CI who were admitted to Cangzhou Central Hospital from January 2018 to January 2020,and they were assigned to the VVS-CI group. At the same time,86 healthy adolescents who were hospitalized in the same period were selected as the research object,and they were set as the healthy group. The P-wave time limit and voltage of 12-lead ECG were compared between the two groups under the basic state,and the characteristics of their changes were analyzed. Results Compared with healthy group,P wave dispersion( PD),P wave maximum time( Max),P wave time( PWD),corrected P wave dispersion( PCD) and corrected P wave maximum time( PCmax) were longer and heart rate was lower in VVS-CI group,with significant differences( P <0. 05). There was no significant difference in P-wave voltage,P-wave minimum time( PMIN),P-wave minimum time( PCMIN) and P-wave correction time( PCWD) between the two groups( P > 0. 05). The analysis of receiver operating characteristic curve showed that PCD,PCmax,PD,Pmax and PWD had better VVS-CI performance( P < 0. 001). The AUC,95% CI,optimal cutoff value,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Yauden index of PCD were 0. 858,0. 784-0. 933,36. 36 ms,83. 73%,72. 09%,3. 00,0. 23,55. 81%,respectively. AUC,95% CI,optimal cutoff value,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Youden index of PCmax were 0. 676,0. 561-0. 792,120. 89%,46. 51%,88. 37%,4. 00,0. 61,34. 88%,respectively. AUC,95% CI,optimal cutoff value,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Youden index of PD were 0. 907,0. 849-0. 965,27. 41 ms,95. 35%,69. 77%,3. 15,0. 07,65. 17%,respectively. AUC,95% CI,optimal cutoff value,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Youden index of Pmax were 0. 853,0. 7666-0. 940,93. 38 ms,76. 74%,90. 70%,8. 25,0. 26,67. 44%,respectively. The AUC,95% CI,optimal cutoff value,sensitivity,specificity,positive pseudoranity ratio,negative pseudoranity ratio,and Youden index of PWD were 0. 731,0. 616-0. 846,78. 48 ms,69. 77%,83. 72%,4. 29,0. 36,53. 49%,respectively. Conclusion PCD,PCmax,PD,Pmax and PWD were significantly prolonged in adolescents with VVS-CI,suggesting abnormal atrial electrical activity. The P-wave boundary value of ECG can be used to diagnose VVS-CI in adolescents.更多还原