疑似冠心病患者运动平板试验中 QT间期及 T波峰末间期的变化研究

摘要

Objective To explore the changes of QT interval, QT interval of heart rate correction ( QTc interval ) , Tpeak-Tend interval ( Tp-Te interval) , Tp-Te/QT, Tp-Te /RR and Tp-Te/QTc of the patients with suspected coronary heart disease ( CHD) in treadmill test.Methods A total of 177 patients without CHD medical history who received treadmill test because of stethalgia in the First Affiliated Hospital of Wenzhou Medical University from January 2006 to May 2014 were analyzed retrospectively.The patients all received treadmill test and coronary arteriography, and according to treadmill test results and coronary arteriography results, they were divided into three groups: group with negative results of treadmill test and coronary arteriography ( group A, n =20 ) , group with positive results of treadmill test and negative results of coronary arteriography (group B, n=69 ) and group with positive results of treadmill test and coronary arteriography (group C, n=88) .We recorded the general data and the results of treadmill test of pre-test and exercise peak and the Duke scores of the three groups.Results The proportion of male and the smoking rate in group C were higher than those in group B (P<0.05) .QT interval, Tp-Te interval, Tp-Te/QTc of exercise peak were lower than those before treadmill test in group A ( P<0.05 ) .QT interval, Tp-Te interval Tp-Te/QT, Tp-Te /RR and Tp-Te/QTc of exercise peak were lower and QTc interval of exercise peak was higher than those before treadmill test in group B ( P<0.05) .QT interval, Tp-Te interval, Tp-Te/QTc of exercise peak were lower and QTc interval, Tp-Te/QT and Tp-Te /RR of exercise peak were higher than those before treadmill test in group C (P<0.05). The difference value of Tp-Te interval in group B was higher than that in group A ( P<0.05 ) .The difference value of QT interval in group C was higher than that in group A (P<0.05).The difference values of Tp-Te interval, Tp-Te/QT, Tp-Te/RR, Tp-Te/QTc in group C were higher than those in group A and group B ( P<0.05) .The Duke scores in group B and group C were lower than thaose in group A (P<0.05); the Duke score of group C was lower than that of B group (P<0.05). The difference values of Tp-Te interval ( r =-0.26, P <0.01), Tp-Te/QT ( r =-0.35, P <0.01), Tp-Te /RR ( r=-0.32, P<0.01) and Tp-Te/QTc (r=-0.17, P=0.03) were negatively correlated with Duke score.Conclusion QT interval, QTc interval, Tp-Te interval, Tp-Te/QT, Tp-Te /RR and Tp-Te/QTc of patients with CHD and non CHD before and after exercise are different, which may have a certain clinical value.%目的：探讨疑似冠心病患者运动平板试验中QT间期、心率校正的QT间期（ QTc间期）、 T波峰末间期（ Tp-Te间期）、 Tp-Te／QT、 Tp-Te ／RR、 Tp-Te／QTc及其变化。方法回顾性分析2006年1月—2014年5月既往无冠心病病史因胸痛来温州医科大学附属第一医院就诊的177例患者的临床资料，均行运动平板试验及冠状动脉造影，根据运动平板试验结果和冠状动脉造影结果分组：运动平板试验结果和冠状动脉造影结果均阴性（A组，20例），运动平板试验结果阳性和冠状动脉造影结果阴性（B组，69例），运动平板试验结果和冠状动脉造影结果均阳性（C组，88例），记录3组患者一般资料、运动平板试验前与运动峰值时运动平板试验结果及Duke评分。结果 C组男性比例、吸烟率高于B组（ P＜0.05）。 A组患者运动峰值时QT间期、 Tp-Te间期、 Tp-Te／QTc较运动平板试验前降低（ P＜0.05）。 B组患者运动峰值时QT间期、 Tp-Te 间期、 Tp-Te／QT、 Tp-Te ／RR、 Tp-Te／QTc较运动平板试验前降低， QTc间期较运动平板试验前升高（ P＜0.05）。 C组患者运动峰值时QT间期、 Tp-Te间期、 Tp-Te／QTc较运动平板试验前降低， QTc间期、 Tp-Te／QT、 Tp-Te ／RR较运动平板试验前升高（ P＜0.05）。 B组患者Tp-Te间期差值较A组升高（P＜0.05）； C组患者QT间期差值较A组升高（P＜0.05）； C组患者Tp-Te间期差值、 Tp-Te／QT差值、 Tp-Te ／RR差值、 Tp-Te／QTc差值较A组和B组升高（ P＜0.05）。 B组和C组患者Duke评分较A组降低（ P＜0.05）； C组患者Duke评分较B组降低（P＜0.05）。 Tp-Te间期差值（r＝－0.26， P＜0.01）、 Tp-Te／QT差值（r＝－0.35， P＜0.01）、Tp-Te ／RR差值（r＝－0.32， P＜0.01）、 Tp-Te／QTc差值（r＝－0.17， P＝0.03）均与Duke评分呈负相关。结论冠心病和非冠心病患者运动前后QT间期、 QTc间期、 Tp-Te间期、 Tp-Te／QT、 Tp-Te ／RR和Tp-Te／QTc变化不同，其可能具有一定的临床价值。