房性心律失常代偿间歇及联律间期与窦房结功能相关性研究

发布时间：2017-12-28 17:30

本文关键词：房性心律失常代偿间歇及联律间期与窦房结功能相关性研究　出处：《广州中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：窦房结功能包括自律性与传导性。目前评价窦房结功能的评价方面包括窦房结自律性试验、窦房结传导试验。食管心房调搏检查目前最具可靠性,但因其具有一定的创伤性,在对于食管病变及心房颤动患者存在禁忌症,缺乏条件的医疗单位难以开展。如何从更简便无创的途径获取支持窦房结功能测定的方法,是临床上一重要课题。本文旨在研究房性心律失常终止后的代偿间歇及联律间期与窦房结功能的内在联系,探究动态心电图对诊断窦房结功能的作用。方法：收集食管心房调搏中窦房结功能异常病例,包括功能低下及障碍情况,为排除迷走神经作用,被检查者均进行阿托品试验。对应动态心电图中房性心律失常终止后的代偿间歇,测算窦房结功能变动时间,区分房性早搏后不同联律间期对窦房结反应的四种区域。计数资料采用χ2检验。诊断性试验中比较两种检查方法(两类计数资料)是否有本质的不同时,采用配对卡方检验(McNemar检验)。进行评价待评价的诊断方法(HOLTER检查)与金标准(TEAP)检查的一致性探究时,采用一致性检验(Kappa检验)。Kappa≥0.75两者一致性较好；0.75Kappa≥0.4两者一致性一般；Kappa0.4两者一致性较差。两独立变量——联律间期(X)与代偿间歇(Y)关系使用相关分析(rank correlation) [58]。分析结果参考：|r|0.3,称为微弱相关,0.3≤|r|0.5,称为低度相关,0.5≤|r|0.8,称为显著(中度)相关,0.8≤|r|1,称为高度相关。检验标准为：P≤0.05为有统计学意义。成果：同时进行TEAP和HOLTER检查的总共64例患者中,在TEAP检查里,53例检出窦房结功能异常,11例属于阴性结果；而HOLTER检查里,55例通过窦房结功能变动时间0.32s的标准诊断为阳性病例,9例为阴性结果；诊断性分析表示敏感度90.57%,特异度36.36%,准确度81.25%,阳性似然比1.42316,阴性似然比为0.25925,HOLTER检查诊断窦房结功能异常的ROC曲线面积为0.693,P值为0.045,基于二项分布的McNemar检验,P=0.774(双侧),P0.05,两种诊断吻合系数Kappa值为0.029,P=0.019,提示两者一致性检验结果较弱,综合各项指标表示当窦房结功能变动时间0.32s时,HOLTER检查能够辅助诊断窦房结功能异常,尤其当窦房结功能变动时间≤320ms时,HOLTER具有排除窦房结功能异常的能力。通过三次对联律间期(X)与代偿间歇(Y)进行相关分析后,其中Pearson分析的系数r分别为0.691,0.610,0.406,大致呈中度相关,P值分别=0.000,0.000,0.001,初步得出联律间期(X)与代偿间歇(Y)两者存在相关关系。联律间期对代偿间歇产生作用,进而间接影响代偿间歇的长短,再进一步反映出窦房结功能程度。结论：HOLTER与TEAP在诊断窦房结功能异常方面具有一致性,HOLTER检查支持辅助诊断窦房结功能异常,尤其体现在当窦房结功能变动时间≤0.32s时,HOLTER具有排除窦房结功能异常的能力,可作为筛选类检查。另外,联律间期与代偿间歇具有相关关系,联律间期间接影响代偿间歇,作用于窦房结功能变动时间的变化,从而证明HOLTER辅助诊断窦房结功能异常的能力。
[Abstract]:Objective: the function of sinoatrial node includes self-discipline and conductivity. The evaluation of sinoatrial node function at present includes the sinoatrial node self-discipline test and sinoatrial node conduction test. Esophageal atrial pacing is the most reliable method at present. However, because of its trauma, there are contraindications for patients with esophageal lesions and atrial fibrillation. It is an important clinical topic how to obtain the method to determine the function of the sinus node from a simpler and less invasive way. The purpose of this study is to investigate the relationship between compensatory interval and interatrial interval after atrial arrhythmias and the function of sinoatrial node, and to explore the role of dynamic electrocardiogram in the diagnosis of sinoatrial node function. Methods: the abnormal atrial node function in esophageal atrial pacing was collected, including functional impairment and dysfunction. Corresponding to the compensatory interval after the termination of atrial arrhythmias in the dynamic electrocardiogram, we calculated the time of functional change of sinoatrial node and distinguished the four regions of the sinoatrial node reaction after different atrial arrhythmias. The count data were tested by x 2. In the diagnostic test, the two methods (two types of counting data) were compared with the essential difference, and the paired chi square test (McNemar test) was used. The consistency test (Kappa test) was used to evaluate the consistency of the diagnostic method (HOLTER examination) and the gold standard (TEAP) examination. Kappa = 0.75, both in good agreement; 0.75Kappa = 0.4 consistency; consistency is Kappa0.4. Two independent variables, X and Y, use correlation analysis (rank correlation) [58]. The analysis results of reference: |r|0.3, known as the weak correlation, 0.3 = |r|0.5, called low correlation, 0.5 = |r|0.8, referred to as significant (moderate), 0.8 = |r|1, known as highly relevant. Test standards: P = 0.05, there was statistically significant. Results: a total of 64 cases of simultaneous TEAP and HOLTER examination in patients in the TEAP examination, 53 cases with sinus node dysfunction, 11 cases are negative results; and HOLTER examination, 55 cases with sinus node function change time of the 0.32s criteria for diagnosis of positive cases, 9 cases were negative results; diagnosis the analysis indicated the sensitivity of 90.57%, specificity of 36.36%, accuracy of 81.25%, positive likelihood ratio 1.42316, negative likelihood ratio was 0.25925, the area of ROC curve of HOLTER examination for the diagnosis of sinus node dysfunction was 0.693, P was 0.045, two distributed McNemar detection based on experience, P=0.774, P0.05 (bilateral), two diagnostic. The coefficient Kappa value is 0.029, P=0.019, suggesting that the two weak consistency test results, comprehensive indicators indicate when the sinoatrial node function change time 0.32s, HOLTER examination can diagnosis sinus node dysfunction, especially when the sinoatrial node function change time 320ms, HOLTER has the ability to eliminate abnormal sinus node function. After analyzing the correlation between the three couplets interval (X) and compensatory interval (Y), the coefficient r of Pearson analysis is 0.691,0.610,0.406, which is approximately moderately correlated, and the P value is =0.000,0.000,0.001 respectively. It is preliminarily concluded that there is a correlation between the interconnecting interval (X) and the compensatory interval (Y). The interval between compensatory intervals and the length of compensatory intermittence can be indirectly affected by interphase interval, and the function degree of sinoatrial node is further reflected. Conclusion: it has the consistency of HOLTER and TEAP in the diagnosis of sinus node dysfunction, HOLTER examination of sinus node dysfunction support diagnosis, especially when the sinoatrial node function change time is less than 0.32s, HOLTER has the ability to eliminate abnormal sinus node function, can be used as a screening test. In addition, there is a correlation between the interlative interval and compensatory interval. The interconnect interval affects the compensatory interval indirectly and acts on the change of the time function of sinoatrial node, which proves the ability of HOLTER to assist the diagnosis of sinus node dysfunction.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.7

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