不同平面QRS-T夹角水平对陈旧性心肌梗死患者心功能不全的评估价值研究

摘要

Objective To study the value of different planar QRS-T angle in the evaluation of cardiac insufficiency in patients with old myocardial infarction.Methods Clinical data of 170 cases with old myocardial infarction,who visited cardiology department in our hospital during March 2009 and September 2015,were retrospectively analyzed.General clinical data,proportion of different QRS-T angle(proportion of QRS-T angle<50°,50°≤QRS-T angle<70°,70°≤QRS-T angle<90°,90°≤QRS-T angle<100° and QRS-T angle≥100°),WBC counts and CK-MB level of the two group of patients with different cardiac function were compared and the correlation between LVEF and QRS-T angle was analyzed.Results WBC counts and CK-MB level of cardiac insufficiency group were higher than normal cardiac function group,and there was difference in proportion of QRS-T angle<50°,90°≤QRS-T angle<100° and QRS-T angle≥100° between cardiac insufficiency group and normal cardiac function group,the difference being statistically significant(P<0.05),indicating that with the decrease of LVEF,the QRS-T angle increased and the planar QRS-T angle was negatively correlated to LVEF value.When LVEF<0.5,the correlation coefficient r=-0.467,P<0.05 and when LVEF<0.35,the correlation coefficient r=-0.489,P<0.05.Sensitivity and specificity of 90°≤QRS-T angle<100° were 95.32% and 94.02%,while sensitivity and specificity of QRS-T angle≥100° were 96.98 and 95.68%,which had statistically significant difference from WBC,CK-MB and other QRS-T angle(P<0.05).Conclusion Different planar QRS-T angles have certain clinical value for evaluating cardiac function,and the planar QRS-T angle is negatively correlated to LVEF value,which is defined as the lower LVEF value,the bigger planar QRS-T angle.When 90°≤QRS-T angle<100° and QRS-T angle≥100°,there are the highest sensitivity and specificity,the difference being not statistically significant between the two,so QRS-T angle≥90° can be used as an indicator for the evaluation of cardiac insufficiency in clinical practice.%目的 研究不同平面QRS-T夹角水平对陈旧性心肌梗死患者心功能不全的评估价值.方法 通过对我院2009年3月至2015年9月心内科就诊治疗的170例陈旧性心肌梗死患者临床资料做回顾性分析,比较两组不同心功能患者间的一般临床资料、不同QRS-T夹角(QRS-T夹角<50°、50°≤QRS-T夹角<70°、70°≤QRS-T夹角<90°和90°≤QRS-T夹角<100°及QRS-T夹角≥100°)所占比例及各组间WBC计数及CK-MB水平,并分析LVEF值和QRS-T夹角相关性.结果 心功能不全组间WBC及CK-MB水平均较心功能正常组高,且平面QRS-T夹角<50°、90°≤QRS-T夹角<100°及QRS-T夹角≥100°在心功能正常和心功能不全组间比较差异有统计学意义(P<0.05),表明随着LVEF值的降低,QRS-T夹角越大,平面QRS-T夹角和LVEF值呈负相关关系,当LVEF<0.5时,相关系数r=-0.467,P<0.05,当LVEF<0.35时,相关系数r=-0.489,P<0.05.90°≤QRS-T夹角<100°和QRS-T夹角≥100°的灵敏度和特异度分别为95.32%、94.02%和96.98%和95.68%,与WBC、CK-MB及其他QRS-T夹角比较差异间均有统计学意义(P<0.05).结论 不同平面QRS-T夹角对于心功能不全的评估均存在一定的临床价值,且平面QRS-T夹角和LVEF值呈负相关关系,LVEF值越小,平面QRS-T夹角越大.当90°≤QRS-T夹角<100°和QRS-T夹角≥100°时灵敏度和特异度最高,两者间无明显差异,故当QRS-T夹角≥90°可作为临床上评估心功能不全的指标之一.