Tp-e间期与慢性心力衰竭患者合并室性心律失常的关系研究

发布时间：2018-09-14 20:13

【摘要】：目的:评价Tp-e间期与慢性心力衰竭(CHF)患者合并室性心律失常的关系以及其对CHF患者合并室性心律失常的诊断价值。方法:收集我院心内科住院的慢性心力衰竭(CHF)患者(心功能NYHAII-IV级)129人(CHF组),将其按有无合并室性心律失常及室性心律失常的类型分为室性期前收缩组36人(室早组,单发室性早搏3000次/24小时或出现二联律、三联律、多源性室性早搏及成对出现的早搏),室性心动过速组40人(室速组),无室性心律失常组53人,纳入同时期在我院住院且行24小时动态心电图(Holter)检查并排除心血管疾病、离子紊乱等影响Tp-e间期的相关疾病后的住院患者67人(对照组),上述入选者均于入院当天行心电图(ECG)检查,住院期间行Holter检查,测量所有入选患者V2导联Tp-e间期值,同时收集其超声心动图及相关实验室检查结果,评价Tp-e间期与CHF患者合并室性心律失常的关系。结果:1.CHF组与对照组相比,总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、心率、射血分数(EF)、左室舒张末内径(LVEDd)存在统计学差异(P0.05),其余观察指标无统计学差异。CHF室早组、CHF室速组、CHF无室性心律失常组三组间比较吸烟史、NYHA心功能分级、血红蛋白(Hb)、EF值及LVEDd存在统计学差异(P0.05)。2.CHF组与对照组QT间期、QTc、QRS间期、Tp-e间期及Tp-e/QT比值比较差异均有统计学意义(P0.05);Tp-e间期及Tp-e/QT比值在室速组、室早组、无室性心律失常组组间比较中差异均有统计学差异(P0.05),且随着室性心律失常严重程度的增高,Tp-e间期及Tp-e/QT比值随之延长。3.当Tp-e间期为105ms,Tp-e/QT比值为0.251时其预测CHF患者合并室性心律失常的灵敏度、特异度及ROC曲线下面积最大。结论:可将Tp-e间期及Tp-e/QT比值作为预测CHF患者合并室性心律失常的非侵入性检查指标。
[Abstract]:Objective: to evaluate the relationship between Tp-e interval and ventricular arrhythmia in (CHF) patients with chronic heart failure and its diagnostic value in CHF patients with ventricular arrhythmia. Methods: a total of 129 (CHF) patients with chronic heart failure (cardiac function NYHAII-IV grade) in our hospital were divided into three groups according to the types of ventricular arrhythmias and ventricular arrhythmias. Single ventricular premature beats occurred in 3000 / 24 hours, or in the second, triple, multisource and paired premature beats), and in the ventricular tachycardia group, 40 patients (ventricular tachycardia group), 53 patients without ventricular arrhythmia, They were admitted to our hospital at the same time and underwent 24 hour ambulatory electrocardiogram (Holter) examination and exclusion of cardiovascular disease. There were 67 inpatients (control group) who suffered from related diseases such as ion disturbance. The patients were examined with (ECG) on the day of admission and Holter during hospitalization. The Tp-e interval of V2 lead was measured in all the patients. The results of echocardiography and laboratory examination were collected to evaluate the relationship between Tp-e interval and ventricular arrhythmia in CHF patients. Results 1. Compared with control group, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), heart rate, Ejection fraction (EF),) left ventricular end-diastolic diameter (LVEDd) was statistically different (P0.05). There were significant differences in EF value of hemoglobin (Hb) and LVEDd between CHF group and control group (P0.05). There were significant differences in QT interval Tp-e interval and Tp-e/QT ratio between CHF group and control group. (P0.05) Tp-e interval and Tp-e/QT ratio in ventricular tachycardia group and early ventricular group were significantly different between CHF group and control group. There were significant differences between the groups without ventricular arrhythmia (P0.05), and with the increase of the severity of ventricular arrhythmias, the Tp-e interval and the ratio of Tp-e/QT were prolonged. 3. The sensitivity, specificity and area under the ROC curve of CHF patients with ventricular arrhythmias were highest when the Tp-e interval was 105 Ms ~ (-1) Tp-e / QT ratio of 0.251. Conclusion: Tp-e interval and Tp-e/QT ratio can be used as noninvasive indexes for predicting ventricular arrhythmia in CHF patients.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541

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