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目的探讨P波离散度(Pd)对原发性高血压伴阵发性心房颤动(PAF)的临床价值。方法记录32例原发性高血压患者伴PAF者(A组)窦性心律时12导联心电图,分别测定最大P波时限(Pmax)、最小P波时限(Pmin)、P波离散度(Pd)、超声心动图测定左心房内径(LAD),与40例单纯原发性高血压者(B组)比较。统计Pd≥40ms、Pmax≥120ms以及Pd≥40ms+Pmax≥120ms阳性例数,计算PAF的灵敏性、特异性。结果Pmax:A组(125.8±17.7)ms显著高于B组(109.4±13.1)ms(P<0.05);Pd:A组(47.7±13.1)ms显著高于B组(31.4±11.6)ms(P<0.05);Pmin、LAD两组差别无统计学意义。单因素回归分析显示:Pmax、Pd、LAD是PAF的预测因子;多因素回归分析显示:Pd是PAF的独立预测因子。Pmax≥120ms预测的敏感性为87.5%,特异性为82.5%;Pd≥40ms预测的敏感性为81.3%,特异性为85%;Pmax>100ms+Pd≥40ms的敏感性为78.1%,特异性为87.5%。结论Pd是原发性高血压伴PAF的独立预测因子,与Pmax联合应用价值更高。
Objective To investigate the clinical value of P wave dispersion (Pd) in patients with essential hypertension complicated with paroxysmal atrial fibrillation (PAF). Methods The 12-lead electrocardiogram was recorded in 32 patients with essential hypertension with PAF (group A). The maximum P wave duration, the minimum P wave duration, the P wave dispersion (Pd ), Left atrial diameter (LAD) by echocardiography, compared with 40 patients with essential hypertension (group B). Statistics Pd≥40ms, Pmax≥120ms and Pd≥40ms + Pmax≥120ms positive cases to calculate the sensitivity and specificity of PAF. Results Pmax was significantly higher in group A (125.8 ± 17.7) ms than in group B (109.4 ± 13.1) ms (P <0.05), significantly higher in group Pd (47.7 ± 13.1) ms than in group B (31.4 ± 11.6) ms P <0.05); Pmin, LAD difference between the two groups was not statistically significant. Univariate regression analysis showed that Pmax, Pd and LAD were the predictors of PAF. Multivariate regression analysis showed that Pd was an independent predictor of PAF. The sensitivity and specificity of Pmax≥120ms were87.5% and82.5%, respectively. The sensitivity and specificity of Pd≥40ms were81.3% and85% respectively. The sensitivity of Pmax> 100ms + Pd≥40ms was78.1%, specificity 87.5%. Conclusion Pd is an independent predictor of essential hypertension with PAF and is more valuable in combination with Pmax.