标题：微伏级T波电交替和窦性心率震荡在冠心病诊断中的临床应用

      作者：孙喜文，陈海坚，吴小敏，苏杭
    (高州市人民医院心血管内科，广东 高州 525200)

      卷次： 2016年27卷11期

      【摘要】 目的 探讨微伏级T波电交替和窦性心率震荡在冠心病诊断中的应用价值。方法 选取 2014年 8
月至2015年8月笔者所在医院心血管内科就诊并经冠状动脉造影及心电图检查证实冠心病患者86例作为研究对
象。根据冠状动脉造影正常或冠状动脉狭窄<50%者为对照组(n=35)，行冠状动脉造影证实相关冠状动脉狭窄>
75%且血流分级≤3级为冠心病组(n=51)，其中冠心病组又分为稳定性心绞痛组(n=27)和陈旧性心肌梗死组(n=
24)。记录并比较各组患者 24 h动态心电图、微伏级T波电交替(MTWA)及窦性心率震荡(HRT)参数的变化以及
MTWA、HRT及MTWA+ HRT预测恶性室性心律失常的灵敏度和特异度。结果 冠心病组患者的MTWA和HRT
阳性率分别为41.2% (21/51)和62.7% (32/51)，明显高于对照组的5.7% (2/35)和17.1% (6/35)，冠心病组的MTWA联
合HRT阳性率为 23.5% (12/51)，也明显高于对照组的 5.7% (2/35)，组间各项指标比较差异均有统计学意义(P<
0.05)；心绞痛组患者的MTWA和HRT阳性率分别为74.1% (20/27)和92.6% (25/27)，明显高于陈旧性心肌梗死组的
4.2% (1/24)和33.3% (8/24)，心肌梗死组的MTWA+HRT阳性率为40.7% (11/27)，明显高于对照组的4.2% (1/24)，组
间各项指标比较差异有统计学意义(P<0.05)；与单项指标相比，MTWA+HRT的灵敏度及特异度相对较高。MTWA
灵敏度和特异度分别为53.3% (8/15)和60.9% (28/46)，HRT灵敏度和特异度分别为66.6% (10/15)和39.1% (18/46)，
MTWA+ HRT灵敏度和特异度分别为71.4% (5/7)和68.8% (22/32)。结论 MTWA、HRT均是评估冠心病患者预后
的重要指标，并且对评价冠心病患者发生恶性室性心律失常及心脏性猝死方面具有更佳的预测水平，而MTWA联
合HRT检测的灵敏度和特异度高于单项指标，可明显提高24 h动态心电图对冠心病的诊断价值。

      【关键词】 微伏级T波电交替；窦性心率震荡；冠心病；应用价值

      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2016）11—1759—03


Clinical application of microvolt T wave alternans and heart rate turbulence in the diagnosis of coronary heart
disease.
SUN Xi-wen, CHEN Hai-jian, WU Xiao-min, SU Hang. Department of Cardiology, the People's Hospital of
Gaozhou, Gaozhou 525200, Guangdong, CHINA

【Abstract】 Objective To discuss the application value of the microvolt T-wave alternans (MTWA) and heart
rate turbulence (HRT) in the diagnosis of coronary heart disease. Methods Eighty-six patients with coronary heart dis-
ease (CHD) in Department of Cardiology in our hospital, who were confirmed coronary heart disease by coronary angi-
ography and electrocardiogram examination, were selected as the study subjects (hospitalized from August 2014 to Au-
gust 2015). Patients with normal coronary angiography or coronary artery stenosis <50% were selected as the control
group (n=35), and the patients with related coronary artery stenosis >75% and blood flow classification≤grade 3 were se-
lected as the coronary heart disease group (CHD group, n=51), which was further divided into stable angina group (n=27)
and old myocardial infarction group (n=24). The changes of 24 h dynamic electrocardiogram, MTWA, HRT were ob-
served, and the sensitivity and specificity of MTWA, HRT and MTWA+HRT for predicting malignant ventricular ar-
rhythmia were recorded and compared. Results The positive rates of MTWA and HRT in CHD group were significant-
ly higher than those of the control group [41.2% (21/51) vs 5.7% (2/35), 62.7% (32/51) vs 17.1% (6/35)], and the positive
rate of MTWA combined with HRT of CHD group was significantly higher than of the control group [23.5% (12/51) vs
5.7% (2/35)], with significant differences in the indexes between two groups (P<0.05). The positive rates of MTWA and
HRT of stable angina group were significantly higher than those of old myocardial infarction group [74.1% (20/27) vs
4.2% (1/24), 92.5% (25/27) vs 33.3% (8/24)], and the positive rate of MTWA+HRT in old myocardial infarction group was
significantly higher than that of the control group [40.7% (11/27) vs 4.2% (1/24)], with statistically significant differences
(P<0.05). Compared with detection by single index, the sensitivity and specificity of MTWA+HRT were relatively high.
The sensitivity and specificity of MTWA were 53.3% (8/15) and 60.9% (28/46), and the sensitivity and specificity of HRT
were 66.6% (10/15) and 39.1% (18/46). The sensitivity and specificity of MTWA+ HRT were 71.4% (5/7) and 68.8% (22/
32), respectively. Conclusion HRT, MTWA are important indicators to assess the prognosis of patients with coronary
heart disease, which has a better prediction value for evaluating malignant ventricular arrhythmia and sudden cardiac death
of the patients. The sensitivity and specificity of MTWA combined with HRT are higher than those of single index, and