广州医科大学学报

目的:探讨高血压患者的动态心电图(Holter),发作性ST段低压与室间隔(IVS)厚度之间的相关性。方法:收集2005年9月至2008年12月在本院住院共88例高血压患者,全部行超声心动图检查未见节段性室壁运动异常,并行冠脉计算机断层血管成像(CTA)未见冠脉狭窄或斑块,根据Holter上有无发作性ST段低压将患者分为2组,分析其与IVS厚度之间的相关性,并比较2组间IVS厚度的大小;然后以单因素及多因素分析筛选高血压患者发作性ST段低压的影响因素;建立受试者操作特征(ROC)曲线评估IVS厚度预测高血压患者有无发作性ST段低压的价值。结果:高血压患者Holter有无发作性压低与IVS厚度呈正相关(r=0.362,P=0.001),伴有发作性ST段压低组IVS厚度与无发作性ST段低压组相比差异有统计学意义(t=3.313,P=0.002);伴有IVS增厚的高血压患者有发作性ST段低压的发生率明显高于无IVS增厚的患者(x²=9.694,P=0.002);多因素分析中只有IVS厚度与发作性ST段低压有相关性(OR=1.710,P=0.002);以IVS厚度预测高血压患者有无发作性ST段低压的ROC曲线下面积(AUC)为0.715±0.067,P=0.002,最佳分界值为10.5 mm,以IVS≥10.5 mm来预测有无发作性ST段压低,敏感性为59.3%,特异性为89.8%。结论:高血压患者IVS厚度与Holter上有无发作性ST段低压呈正相关;以IVS厚度预测高血压患者有无发作性ST低压的特异性较高,但敏感性较差。

Objective:To analyze the correlation between the paroxysmal ST depression on Holler ECG and thickness of interventricular septum(IVS ) on echocardiography in hypertensive patients.Methods:From September 2005 to December 2008,data of 88 hospitalized hypertensive patients with no ventricular segmental wall motion abnormality on echocardiography and no stenosis or plaque on coronary computed tomographic angiography(CTA) were collected and divided into two groups according to the presence of paroxysmal ST depression on Holter ECG.The correlation between paroxysmal ST depression and thickness of IVS was analyzed in the group with paroxysmal ST depression.In addition,the thickness of IVS was then compared between the two groups.Univariate and multivariate analysis were used to screen the influential factors of paroxysmal ST depression in hypertensive patients.The receiver operating characteristic(ROC) curves were established to assess the value of IVS thickness in predicting paroxysmal ST depression in hypertensive patients.Results:Paroxysmal ST depression on Holter ECG was positively correlated with the thickness of IVS in hypertensive patients(r = 0.362, P=0.001 ).There was a statistical difference in the thickness of IVS between the groups with or without the presence of paroxysmal ST depression(t =3.313,P =0.002).The incidence rate of paroxysmal ST depression was significantly higher in the hypertensive patients with thickened IVS than in those without increased thickness of IVS(x²=9.694,P =0.002).Multivariate analysis revealed that only the thickness of IVS was associated with paroxysmal ST depression(OR = 1.710,P =0.002).The area under cure(AUC) of the ROC curve was 0.715±0.067(P=0.002) when IVS thickness was used to predict the presence of paroxysmal ST depression in hypertensive patients,with the optimal cut-off value being 10.5mm.Furthermore,the sensitivity was 59.3%and specificity 89.8%using IVS≥10.5mm as a predictor for paroxysmal ST depression.Conclusion:The thickness of IVS was positively associated with presence of ST depression on Holter ECG in hypertensive patients. Thickness of IVS had a relatively higher specificity but lower sensitivity in predicting the presence of paroxysmal ST depression in hypertensive patients.