【摘要】 目的 :观察冠心病患者潘生丁试验前后心电图 ST段、校正 QT间期 ( QTc)及 QT间期离散度 ( QTd)的变化 ,以探讨潘生丁试验时诊断冠心病的更敏感及特异的指标。方法 :对 30例冠心病患者 (冠心病组 )及 32例正常者 (对照组 )进行潘生丁试验 ,记录试验前后 12导联同步心电图 ,测量其 ST段 ,QTc及 QTd的改变。根据受试者作业特征曲线 ( ROC曲线 )求出 QTc及 QTd的阳性分界点 ,结合传统诊断标准 ST段下移≥ 0 .1m V,分别计算其特异性及敏感性。并与“并联诊断”方法进行比较。结果 :以潘生丁试验诊断冠心病时 ,如分别以 ST段下移≥ 0 .1m V、QTc≥ 44 0 ms、QTd≥ 40 ms为标准 ,其特异性分别为 10 0 %、6 8.8%、93.8% ;敏感性分别为 5 3.3%、83.3%和 87.6 %。如采用“并联诊断”方法 ,分别以 ST段下移≥ 0 .1m V和 QTc≥ 44 0 ms、ST段下移≥ 0 .1m V和QTd≥ 40 m s、QTc≥ 44 0 m s和 QTd≥ 40 m s为标准 ,其特异性分别为 6 8.8%、93.8%、6 8.8%。敏感性分别为70 .0 %、96 .8%、90 .0 %。结论 :在潘生丁试验时 ,如以传统的诊断标准 ( ST段下移≥ 0 .1m V ) ,结合 QTd≥ 40 m s,可明显提高其诊断的敏感性而不影响其特异性 ,QTd≥ 40 ms可作为潘生丁试验时诊断冠心病的一项重要参考指标更多还原

【Abstract】 Objective:To investigate the value of QTc and QTd combined with ECG in dipyridamole test in the diagnosis of coronary heart disease and to determine the more sensitive and specific criteria.Method:30 patients with coronary heart disease and 32 normal controls were undergone dipyridamole test.ST segment,QTc and QTd were measured in 12 lead synchronizing ECG recorded before and during the test.The specificity and sensitivity of each criterion were calculated according to the positive dividing point on ROC curve combined with traditional criterion of ST segment depression equal or more than 0.1 mV.This was also compared with the method of “combining diagnostic criteria”.Result:It showed that using ST segment depression ≥ 0.1 mV,QTc ≥440 ms and QTd≥40 ms as diagnostic criteria for dipyridamole test,the specificity of the above criteria was 100%, 68.8 % and 93.8 %,respectively,and the sensitivity, 53.3 %, 83.3 % and 87.6 %,respectively.By combining the diagnostic criteria of ST segment depression ≥ 0.1 mV and QTc≥440 ms,ST segment depression ≥ 0.1 mV and QTd≥40 ms,and QTc≥440 ms and QTd≥40 ms,the specificity of the above criteria was 68.8 %, 93.8 %,and 68.8 %,respectively,and the sensitivity, 70.0 %, 96.8 % and 90.0 %,respectively.Conclusion:It suggested that the traditional criteria of ST segment depression ≥ 0.1 mV combined with QTd≥40 ms during dipyridamole test might increase the sensitivity of the diagnosis of coronary heart disease while did not significantly decrease the specificity,which suggests that QTd≥40 ms during dipyridamole test might be used as an important index in the diagnosis of coronary heart disease.更多还原