上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (10): 1162-.doi: 10.3969/j.issn.1674-8115.2019.10.010

• 论著·临床研究 • 上一篇    下一篇

冠状动脉粥样硬化性心脏病患者碎裂QRS波的分布特征及其与左心室重构的关系

苏海霞，朱雅琴，张天贶，张绘莉，顾 俊   

  1. 上海交通大学医学院附属第九人民医院心血管内科，上海 200011
  • 出版日期:2019-10-28 发布日期:2019-11-22
  • 通讯作者: 张绘莉，电子信箱：huilizhang815@163.com。
  • 作者简介:苏海霞（1971—），女，主治医师，硕士；电子信箱：13917216309@163.com。
  • 基金资助:
    国家自然科学基金（81570037）；上海市科学技术委员会医学引导类（西医）科技支撑项目（19411963300）

Distribution characteristics of fragmented QRS in patients with coronary atherosclerotic heart disease and its relationship with left ventricular remodeling

SU Hai-xia, ZHU Ya-qin, ZHANG Tian-kuang, ZHANG Hui-li, GU Jun   

  1. Department of Cardiovascular Medicine, Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2019-10-28 Published:2019-11-22
  • Supported by:
    National Natural Science Foundation of China, 81570037; Science and Technology Support Project of Medical Guidance (Western Medicine) of Shanghai Municipal Committee of Science and Technology, 19411963300

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摘要： 目的·探讨碎裂QRS波（fragmented QRS，fQRS）对冠状动脉粥样硬化性心脏病（冠心病）的诊断价值，并分析其与左心室重构的关系。方法·选择2016年11月—2018年10月于上海交通大学医学院附属第九人民医院心血管内科住院期间行冠状动脉造影检查的患者498例，根据造影检查结果将患者分为对照组（203例，冠状动脉造影为阴性或狭窄χ2检验比较3组患者常规心电图fQRS阳性[fQRS（+） ]的发生率。将230例狭窄≥30%的单支病变患者按照受累血管分为前降支病变组（128例）、右冠病变组（59例）和回旋支病变组（43例），采用非参数检验法分析fQRS（+）导联与病变血管的关系。最后，将所有入组患者分为fQRS（+）组（86例）和fQRS阴性[fQRS（-） ]组（412例），采用二元Logistic回归模型分析fQRS与左心室射血分数（left ventricular ejection fraction，LVEF）、左心室舒张末期容积（left ventricular end-diastolic volume，LVEDV）、左心室收缩末期容积（left ventricular end-systolic volume，LVESV）、室间隔厚度（interventricular septum thickness，IVST）和左心室后壁厚度（left ventricular posterior wall thickness，LVPWT）的相关性。结果·R×C列联表χ2检验显示，3组患者fQRS（+）的发生率分别为8.89%、16.13%和30.71%，差异具有统计学意义（均PⅡ、Ⅲ、AVF、V1、V2）fQRS多出现于右冠病变组，高侧壁导联（Ⅰ、AVL）fQRS多出现于回旋支病变组，差异具有统计学意义（均Pr-0.030，OR0.971，95% CI为0.945～0.997，P0.029），与LVESV呈正相关（r0.042，OR1.043，95% CI为1.005～1.082，P0.026）。结论·fQRS对冠心病的临床诊断有一定的参考价值，左心室重构可能是fQRS发生的机制之一。

关键词: 碎裂QRS波, 冠状动脉造影, 冠心病, 左心室重构

Abstract:

Objective · To explore the diagnostic value of fragmented QRS (fQRS) for coronary atherosclerotic heart disease (CHD), and to analyze its relationship with left ventricular remodeling. Methods · Nov. 2016 to Oct. 2018, 498 hospitalized patients in the Department of Cardiovascular Medicine of Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine were selected consecutively. During the hospitalization, all the patients underwent coronary angiography. According to the angiographic results, the patients were divided into the control group (203 patients with negative or coronary stenosis ≥75%). The incidences of fQRS(+) in the normal electrocardiogram among the three groups were comparedchi-square test of R×C contingency table. Two hundred and thirty patients with single-vessel stenosis≥30% were divided into the anterior descending branch group (128 cases), the right coronary branch group (59 cases), and the circumflex branch group (43 cases), and the relationship between fQRS(+) leads and diseased vessels was analyzednonparametric test. Finally, all the patients were divided into fQRS(+) group (86 cases) and fQRS(-) group (412 cases). The correlation between fQRS and left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), interventricular septum thickness (IVST) and left ventricular posterior wall thickness (LVPWT), respectively, were analyzedbinary Logistic regression model. Results · The chi-square test of R×C contingency showed that the incidences of fQRS(+) in the three groups were 8.89%, 16.13% and 30.71%, respectively, with statistically significant differences (all P Ⅱ, Ⅲ, AVF, V1, V2) were more common in the right coronary branch group, the fQRS(+) leads reflecting upper lateral wall (Ⅰ, AVL) were more common in the circumflex branch group, with statistically significant differences (all P0.05). Binary Logistic regression analysis showed that fQRS was negatively correlated with LVEF (r-0.030, OR0.971, 95% CI 0.945-0.997, P0.029), and positively correlated with LVESV (r0.042, OR1.043, 95% CI 1.005-1.082, P0.026). Conclusion · fQRS has certain reference value in the clinical diagnosis of CHD, and left ventricular remodeling may be one of the mechanisms of fQRS.

Key words: fragmented QRS (fQRS), coronary angiography, coronary atherosclerotic heart disease (CHD), left ventricular remodeling

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