冠心病患者颈动脉硬化与异常心电图的关系和与血压的相关性

摘要

目的：探讨冠心病患者颈动脉硬化（CAS）与异常心电图的关系及与血压的相关性。方法：收集冠心病患者389例，分为 CAS 组213例，无 CAS 组176例。比较两组患者的心电图异常情况，同时比较 CAS 组内不同程度CAS 患者间的心电图及血压情况。结果：与无 CAS 组比较，CAS 组的房颤、Ⅱ～Ⅲ度房室传导阻滞、ST 段压低总导联、异常 T 波总导联、ST 段偏移伴 T 波异常、心绞痛伴 ST 段压低的构成比例均显著增大（P ＜0.05～＜0.01）。随着 CAS 级别的增加（I 级～IV 级），房颤（8.33％比21.33％比31.03％比45.00％）、ST 段压低总导联数（17.64％比27.22％比37.07％比52.08％）、异常 T 波总导联数（5.00％比6.56％比10.34％比22.08％）、ST段偏移伴 T 波异常（26.67％比37.33％比50.00％比60.00％）的比例逐渐增加（P ＜0.05或＜0.01）。CAS 患者和无 CAS 患者的舒张压（DBP）无明显差异，CAS 患者的收缩压（SBP）、脉压（PP）明显高于无 CAS 患者，且随着 CAS 程度的增加而逐渐增加（P ＜0.05～＜0.01）。Pearson 相关分析显示，CAS 与 SBP、PP 呈明显正相关（r＝0.838、0.674，P 均＜0.01）。结论：伴颈动脉硬化的冠心病患者异常心电图的发生率较无颈动脉硬化冠心病患者的显著升高，且颈动脉硬化与收缩压、脉压呈正相关。因此，颈动脉硬化能较好地反映冠心病患者病情。%Objective:To explore the relationship between carotid atherosclerosis (CAS)detected by ultrasonography and ECG abnormality and correlation between CAS and blood pressure in patients with coronary heart disease (CHD).Methods:A total of 389 CHD patients were divided into CAS group (n=213)and no CAS group (n=176).ECG abnormalities were compared between two groups,and ECG and blood pressure were compared among patients with different degrees of CAS in CAS group.Results:Compared with no CAS group,there were significant rise in constituent ratios of atrial fibrillation,Ⅱ~Ⅲ°atrioventricular block,total lead number of ST segment de-pression,and of abnormal T wave,ST segment deviation complicated abnormal T wave and angina pectoris compli-cated ST segment depression in CAS group (P <0.05~<0.01).Along with CAS grade increased (grade I~ grade IV),there were gradual rise in percentages of atrial fibrillation (8.33% vs.21.33% vs.31.03% vs.45.00%),to-tal lead number of ST segment depression (17.64% vs.27.22% vs.37.07% vs.52.08%),total lead number of ab-normal T wave (5.00% vs.6.56% vs.10.34% vs.22.08%)and ST segment deviation complicated abnormal T wave (26.67% vs.37.33% vs.50.00% vs.60.00%),P <0.05 or <0.01. There were no significant difference in diastolic blood pressure (DBP)between no CAS group and CAS group,but systolic blood pressure (SBP)and pulse pressure (PP)of CAS patients were significantly higher than those of no CAS patients,and they gradually elevated along with CAS severity increased (P <0.05~<0.01).Pearson correlation analysis indicated that CAS was signifi-cant positively correlated with SBP and PP (r =2.064,1.348,P <0.01 both).Conclusion:The incidence rate of abnormal ECG in CHD patients complicated CAS is higher than that of CHD patients without CAS;and CAS is pos-itively correlated with blood pressure.Therefore,carotid ultrasonography can better reflect CHD patients′condition.