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不同性别肺动脉高压患者心电图特征分析
刘贤国
李杰英
刘春丽
王欣妮
崔江禹
张挪富
洪城
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1001-0939.2018.09.015
Analysis of the characteristics of electrocardiogram in patients of different genders with pulmonary hypertension
Liu Xianguo
Li Jieying
Liu Chunli
Wang Xinni
Cui Jiangyu
Zhang Nuofu
Hong Cheng
Authors Info & Affiliations
Liu Xianguo
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Li Jieying
Liu Chunli
Wang Xinni
Cui Jiangyu
Zhang Nuofu
Hong Cheng
·
DOI： 10.3760/cma.j.issn.1001-0939.2018.09.015
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摘要

目的分析肺动脉高压(PH)患者的心电图特征，探讨不同性别PH患者心电图参数与肺血管阻力(PVR)、平均肺动脉压力(mPAP)和心脏指数的相关性。

方法回顾性分析2015年8月至2017年10月就诊于广州医科大学附属第一医院呼吸科共101例行右心导管检查确诊PH的患者，排除肺动脉压力正常、临床资料不全及重复检查者。根据性别分组，其中男性组53例，年龄16～87岁，平均(56±14)岁；女性组48例，年龄17～85岁，平均(52±17)岁，两组间年龄差异无统计学意义( P＝0.287)。收集心电图各项参数结果及右心导管结果，分析不同性别患者心电图特征及与肺血管阻力、平均肺动脉压力、心脏指数的相关性。

结果在所有PH患者中，男性组QRS电轴时限为(110±16)ms，与女性组[(99±18)ms]比较差异有统计学意义( P<0.001)，男性组V5导联S波幅[(1.3±1.4)mv]明显高于女性组[(0.6±0.7)mv]，差异有统计学意义( P<0.001)。心率校正的QT间期、QRS电轴、Ⅰ导联S波幅、V1导联S和R波幅，V1导联R/S比值、V5导联S波幅与PVR均有相关性，其中V1导联S波幅呈负相关( r＝－0.441， P<0.001)。男性组患者V1导联R/S比值、V5导联S波幅与PVR无相关性。女性组QT间期、V1导联R波幅、V1导联R/S比值与PVR无相关性。所有患者Ⅱ导联P波时限，QRS电轴、Ⅰ导联S波幅、V1导联S波、R波幅，V5导联S波幅、QT间期、V1导联R/S比值与平均肺动脉压力均有相关性(均 P<0.05)。男性组与QT间期、Ⅱ导联P波时限、V5导联S波幅无相关性(均 P>0.05)。而女性组平均肺动脉压力仅与V1导联S波、R波幅、Ⅰ导联S波幅、V5导联S波幅相关(均 P<0.05)。心脏指数与V1导联S波幅呈正相关( r＝0.34， P<0.001)，与QRS电轴呈负相关( r＝－0.219， P＝0.04)；男性组心脏指数与QRS电轴无相关性( P＝0.073)，而与心率校正的QT间期呈负相关( r＝－0.296， P＝0.044)。

结论肺动脉高压患者心电图中QRS时限、V5导联S波幅有性别差异，QRS电轴和V1导联S波幅与心脏指数有相关性。不同性别肺动脉高压患者的心电图与肺血管阻力、平均肺动脉压力、心脏指数的相关性存在差异。

高血压，肺性;心电图;肺血管阻力
ABSTRACT

ObjectiveTo analyze the characteristics of ECG in patients with pulmonary hypertension(PH) and explore their correlation with pulmonary vascular resistance(PVR), mean pulmonary arterial hypertension(mPAP) and cardiac index(CI).

MethodsA total of 186 patients with right heart catheterization were enrolled in the Department of Respiratory of the First Affiliated Hospital of Guangzhou Medical University from August 2015 to October 2017. Patients with normal pulmonary artery pressure, incomplete clinical data and repeated examinations were excluded and there were 101 patients with pulmonary hypertension included. The results of ECG parameters and right heart catheterization were collected to analyze the ECG characteristics of patients with different genders and their correlation with PVR, mPAP and CI.

ResultsAmong all PH patients, the duration of QRS axial in male group was significantly longer than that of the female group [(110.38±15.829) vs. (98.63±18.041) ms, P<0.001], and the S wave amplitude in V5 was significantly higher compared to female group [(1.304±1.356) vs. (0.648±0.663) mv, P<0.001]. Their heart rate-corrected QT interval (QTc), QRS axis, S wave amplitude in Ⅰ, S and R wave amplitude in V1, R/S ratio in V1, S wave amplitude V5, all had a correlation with their PVR and the S wave amplitude in V1 was negatively correlated with PVR ( r=-0.441, P<0.001). In the male group, PVR was not correlated with R/S ratio in V1 and S wave amplitude in V5. While PVR in the female group was significantly correlated with QTc, R wave amplitude in V1, R / S ratio in V1. In all PH patients, their P wave duration in Ⅱ, QRS axis and S wave amplitude in Ⅰ, S wave and R wave amplitude in V1, S wave amplitude in V5, QTc, R/S ratio in V1, all had correlations with mPAP ( P<0.05). In male group, mPAP was not correlated with QTc, P wave duration in Ⅱ, and the S wave amplitude in V5 ( P>0.05). The mPAP in the female group was only related to the S wave and R wave amplitude in V1, and S amplitude in Ⅰ and S wave amplitude in V5 ( P<0.05). The CI was positively correlated with the S wave amplitude in V1 ( r=0.34, P<0.001), and negatively correlated with the QRS axis ( r=-0.219, P=0.04); CI in male group was not correlated with QRS axis( P=0.073), but correlated with QTc ( r=-0.296, P=0.044).

ConclusionThere were gender differences in QRS duration and S wave amplitude in V5 in patients with pulmonary hypertension. The QRS axis and the S wave amplitude in V1 were related to the heart index. There was a difference in the correlation between ECG and PVR, mPAP and CI in patients of different genders with pulmonary hypertension.

Hypertension, pulmonary;Electrocardiogram;Pulmonary vascular resistance
Hong Cheng, Email: mocdef.6ab21chyyfyg
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引用本文

刘贤国,李杰英,刘春丽,等. 不同性别肺动脉高压患者心电图特征分析[J]. 中华结核和呼吸杂志,2018,41(9)：728-733.

DOI:10.3760/cma.j.issn.1001-0939.2018.09.015

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肺动脉高压(pulmonary hypertension, PH)是以肺血管阻力进行性升高为主要特点的恶性肺血管疾病，继续发展可导致右心功能衰竭甚至是死亡 [ 1 ]。肺动脉高压患者的肺血管阻力持续增高将导致右心室的后负荷增加，最终产生右心室及右心房扩大及血管重塑 [ 2 , 3 ]，可出现心电图的特异表现以及心功能的改变。有作者报道女性PH患者的心率校正的QT间期(heartrate－corrected QT interval, QTc)和QTc离散度(QTc dispersion, QTcd)与平均肺动脉压正相关，且在重度PH患者中显著增高 [ 4 ]。本研究通过观察PH患者心电图特征，比较其与PVR、mPAP及心脏指数的相关性，分析不同性别患者之间的差异。
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