特发性与器质性心脏病室性心动过速的心室复极参数的比较

发布时间：2018-02-26 23:25

  本文关键词： 特发性室性心动过速 器质性心脏病室性心动过速 心室复极 T波形态学　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:室性心动过速常发生于各种器质性心脏病患者,但也可发生在无明确器质性心脏病证据的中青年患者。特发性室性心动过速(idiopathic Ventricular tachycardia,IVT简称特发性室速)指发生在心脏结构正常的病人,目前的诊断技术未发现器质性心脏病,也无电解质异常和离子通道功能异常等。其发生率约占全部室速的10%,以青壮年居多。特发性室速由于无基础心脏病变,多数血流动力学稳定,且射频消融成功率高,通常预后良好。器质性心脏病室性心动过速(简称器质性心脏病室速)由于基础心脏病变的持续存在,室性心动过速反复发作,且药物和射频消融治疗效果欠佳,对于器质性心脏病持续性室速和室扑/室颤,植入型心律转复除颤器(ICD)治疗是Ⅰ类适应证。特发性室速的发生机制目前尚不明确,其能否像器质性室速一样引起心电图的复极改变也研究较少。目的:本研究旨在分析健康人群和特发性室速患者、器质性心脏病室速患者的心室复极参数,首先,明确三组间心室复极参数及T波形态学参数是否存在差异;其次,探讨心电图心室复极各个参数对器质性心脏病室速的预测价值;最后,明确针对室性心律失常危险分层预测价值较好的复极参数。方法:选取大连医科大学附属第一医院的特发性室速患者55例,器质性心脏病室速患者41例,同时选取年龄、性别等因素同特发性室速组相匹配的健康对照组110例,采集所有患者窦性心律心电图,对心电图的心室复极参数QTc、TpTe、QTd、Tax(T波电轴)、立体QRS-T夹角及T波的形态学参数(PCA、MCS-score、VAngT_F、VAngT_S、VAngT_T、VMaxT_F、VMaxT_S、VMaxT_T、Ta_V5、Td_V5、bmTar_V5)进行分析,比较三组患者参数的差异。结果:1.三组间心室复极各参数的比较:健康人群组和特发性室速组间QTc间期、立体QRS-T夹角、Tp-Te间期差异有统计学意义(P0.01,P=0.04,P=0.02),QTd、Tax无统计学差异(P=0.24,P=0.32)。健康人群组和器质性心脏病室速组间QTc间期、立体QRS-T夹角、Tp-Te间期、QTd、Tax差异有统计学意义(P0.01,P0.01,P=0.01,P0.01,P0.01)。特发性和器质性心脏病室速组间QTc间期、立体QRS-T夹角、Tax差异有统计学意义(P0.01,P0.01,P0.01),Tp-Te 间期、QTd 无统计学差异(P=0.59,P=0.10)。2.心室复极参数预测器质性心脏病室速的ROC曲线,比较心电图心室复极各个参数对器质性心脏病室速的预测价值:立体QRS-T夹角曲线下面积为0.916,用于判断器质性心脏病室速有显著意义(P0.01);QTc间期、Tax曲线下面积分别为0.736、0.752,用于判断器质性心脏病室速诊断价值尚可(P0.01,P0.01)。3.T波形态学参数:健康人群组和特发性室速组间PCA、MCS-score、VAngT_S、VMaxT_F、VMaxT_T、ta_V5、bmTar_V5 差异有统计学意义(P0.01,P=0.04,P=0.02,P=0.02,P=0.03,P=0.01,P=0.01);VAngT_F、VAngT_T、VMaxT_S、td_V5无统计学差异(P=0.97,P=0.54,P=0.30,P=0.84)。健康人群组和器质性心脏病室速组间 PCA、MCS-score、VAngT_F、VAngT_S、VAngT_T、VMaxT_F、ta_V5、td_V5、bmTar_V5 差异有统计学意义(P0.01,P0.01,P0.01,P=0.02,P0.01,P0.01,P0.01,P0.01,P0.01);VMaxT_S、VMaxT_T无统计学差异(P=0.87,P=0.23)。特发性室速组和器质性心脏病室速组间PCA、MCS-score、VAngT_F、VAngT_S、VAngT_T、ta_V5、td_V5、bmTar_V5 差异有统计学意义(P0.01,P0.01,P0.01,P0.01,P0.01,P0.01,P0.01,P0.01);VMaxT_F、VMaxT_S、VMaxT_T 无统计学差异(P=0.06,P=0.33,P=0.47)。4.T波形态学参数预测器质性心脏病室速R0C曲线,比较T波形态学参数对器质性心脏病室速的预测价值:PCA、VAngT_S、VAngT_T、ta_V5、bmTar_V5、Tax 曲线下面积为 0.725、0.755、0.752、0.803、0.812、0.752,用于判断器质性心脏病室速诊断价值较好;MCS-score、VAngT_F、VMaxT_F、td__V5曲线下面积为0.629、0.634、0.656、0.615,用于判断器质性心脏病室速诊断价值尚可。结论:1.室速患者的心室复极参数不同于正常人,其中,器质性心脏病室速的心室复极参数的变化最大,特发性室速次之。特发性室速一些心室复极参数较对照组发生改变,提示特发性室速患者可能存在室速发生的电生理基质。2.特发性和器质性心脏病室速心室复极参数存在差异,提示两种室速基质存在差异或电生理机制不同。3.立体QRS-T夹角、Tax及T波形态学部分参数三组间差异最大,是室性心律失常危险分层较好的复极参数。
[Abstract]:Background: ventricular tachycardia occurs in all patients with organic heart disease, but also can occur in no clear evidence of organic heart disease in young patients with idiopathic ventricular tachycardia (idiopathic Ventricular tachycardia IVT, referred to as idiopathic ventricular tachycardia) occurs in normal heart structure the patient, diagnosis technique is found no organic heart disease, no abnormal electrolyte and ion channel dysfunction. Total 10% the incidence of ventricular tachycardia, mostly in young adults. Idiopathic ventricular tachycardia without underlying heart diseases, most hemodynamic stability, and high success rate of radiofrequency ablation usually, a good prognosis. Organic heart ventricular tachycardia (referred to as organic heart disease due to persistent heart disease rate) of ventricular tachycardia, recurrent, and drugs and the efficacy of radiofrequency ablation for poor organic heart disease Sustained ventricular tachycardia and ventricular fibrillation / flutter, implantable cardioverter defibrillator (ICD) therapy is a class I indications. Pathogenesis of idiopathic ventricular tachycardia is unclear, it can also study changes of ECG repolarization like organic ventricular tachycardia caused. Objective: This study aimed to analyze the healthy people and patients with idiopathic ventricular tachycardia, ventricular repolarization and ventricular tachycardia in patients with organic heart first, clear between the three groups of ventricular repolarization parameters and T wave morphology parameters whether there are differences; secondly, to investigate the electrocardiogram of ventricular repolarization parameters for the predictive value of organic heart disease rate; finally, according to the clear room arrhythmia risk stratification predict repolarization good value. Methods: the First Affiliated Hospital of Dalian Medical University of patients with idiopathic ventricular tachycardia in 55 cases, for patients with cardiac ventricular tachycardia in 41 cases, and select the age, gender and other factors with idiopathic Vt group matched healthy control group of 110 patients, collected all patients with sinus rhythm ECG, ventricular repolarization parameters QTc, QTd, TpTe on ECG, Tax (T wave axis), the morphological parameters of stereo QRS-T angle and T waves (PCA, MCS-score, VAngT_F, VAngT_S, VAngT_T, VMaxT_F, VMaxT_S VMaxT_T, Ta_V5, Td_V5, bmTar_V5), analyze, compare the difference between the three groups. Results: comparison of 1. parameters between the three groups of ventricular repolarization parameters: healthy group and idiopathic ventricular tachycardia group between QTc interval, stereo QRS-T angle, Tp-Te interval was statistically significant differences (P0.01, P=0.04, P=0.02) QTd, Tax, no statistical difference (P=0.24, P=0.32). The healthy group and organic heart disease rate between group QTc interval, Tp-Te interval, QRS-T stereo angle, QTd, there were significant differences in Tax (P0.01, P0.01, P=0.01, P0.01, P0.01). Idiopathic ventricular tachycardia and organic group QTc interval, QRS- stereo T angle, there were significant differences in Tax (P0.01, P0.01, P0.01), Tp-Te interval, QTd no significant difference (P=0.59, P=0.10) ROC curve.2. predictor of ventricular repolarization parameters cardiac ventricular tachycardia in the predictive value of ECG ventricular repolarization parameters on organic heart disease rate: area QRS-T stereo angle curve for the 0.916, used to determine the organic heart disease rate was significant (P0.01); QTc interval, area under the Tax curve were used to determine the 0.736,0.752, organic heart disease diagnosis speed (P0.01, P0.01) is.3.T wave morphology parameters: healthy group and idiopathic ventricular tachycardia group PCA. MCS-score, VAngT_S, VMaxT_F, VMaxT_T, ta_V5, bmTar_V5 difference was statistically significant (P0.01, P=0.04, P=0.02, P=0.02, P=0.03, P=0.01, P=0.01); VAngT_F, VAngT_T, VMaxT_S, no significant difference between td_V5 (P=0.97, P=0.54, P=0.30, P=0.84). The healthy group And organic heart disease rate between group PCA, MCS-score, VAngT_F, VAngT_S, VAngT_T, VMaxT_F, ta_V5, td_V5, bmTar_V5 difference was statistically significant (P0.01, P0.01, P0.01, P=0.02, P0.01, P0.01, P0.01, P0.01, VMaxT_S, P0.01); no significant difference between VMaxT_T (P=0.87, P=0.23) idiopathic. VT group and organic heart disease rate between group PCA, MCS-score, VAngT_F, VAngT_S, VAngT_T, ta_V5, td_V5, bmTar_V5 difference was statistically significant (P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, VMaxT_F, VMaxT_S, P0.01); no significant difference between VMaxT_T (P=0.06, P=0.33, P=0.47.4.T wave morphology parameters) predictor cardiac ventricular tachycardia in the R0C curve, the predictive value of T wave morphology parameters of organic heart disease rate: PCA, VAngT_S, VAngT_T, ta_V5, bmTar_V5, the area under the Tax curve was used to determine 0.725,0.755,0.752,0.803,0.812,0.752, organic heart disease diagnosis rate of price The value of MCS-score, VAngT_F, VMaxT_F is better; and the area under the td__V5 curve was used to determine 0.629,0.634,0.656,0.615, organic heart disease diagnosis can speed. Conclusion: the ventricular repolarization parameters of 1. patients with ventricular tachycardia is different from normal people, the changes of ventricular repolarization parameters of organic heart disease rate maximum, idiopathic ventricular the speed of idiopathic ventricular tachycardia. Some ventricular repolarization parameters compared with the control group changed, suggesting that idiopathic ventricular tachycardia patients may be the electrophysiological matrix.2. of idiopathic ventricular tachycardia and ventricular tachycardia in cardiac ventricular repolarization parameters are different, suggesting that the two ventricular tachycardia matrix differences or electrophysiological mechanism different.3. stereo QRS-T angle, the difference between the three groups of Tax and T wave morphology parameters is the maximum repolarization ventricular arrhythmia risk stratification is better.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.71
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本文编号：1540150