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目的调查和评估正常人额面QRS电轴的年龄趋势以及对肢体导联QRS波振幅的影响。方法采集5360例(男性3614例、女性1746例,年龄范围18～84岁)正常健康人12导联心电图分为5个年龄组,计算和分析各年龄组额面QRS电轴的中位数以及肢体导联QRS波振幅的中位数和96%的正常范围上、下限。结果随年龄增长,男、女额面QRS中位数电轴一致性地逐渐向左(上)偏移大约27°(从70°偏移到43°,P＜0．001)。Ⅰ和aVL导联的R波振幅随年龄增长显著增加(P＜0．001),而下壁导联Ⅱ、Ⅲ和aVF的R波振幅随年龄增长显著降低(P＞0．001)。肢体导联R波振幅随年龄的变化趋势与额面QRS电轴的年龄趋势相一致。结论正常人额面QRS电轴随年龄增长逐渐向左(上)偏移,呈现明确的年龄趋势。QRS电轴的生理性演变可引起肢体导联QRS波振幅呈现明显的年龄差异。显然,把一个相同的左心室肥大心电图诊断标准应用到不同年龄组人群是不合适的。
Objective To investigate and evaluate the age trend of QRS axis in normal subjects and the influence of limbs QRS amplitude. Methods A total of 5360 patients (3614 males and 1746 females, aged 18-84 years) were enrolled in this study. The 12-lead electrocardiogram was divided into five age groups. The median frontal QRS axis was calculated and analyzed. The median QRS amplitude of limb leads and the upper and lower limits of 96% of the normal range. Results As the age increased, the median QRS of the male and female facets gradually shifted left (up) by about 27 ° (from 70 ° to 43 °, P <0.001). The amplitude of R wave in Ⅰ and aVL leads increased significantly with age (P <0.001), while the amplitude of R wave in lower leads Ⅱ, Ⅲ and aVF decreased significantly with age (P> 0.001). The trend of limb lead R wave amplitude with age is consistent with the age trend of frontal QRS axis. Conclusion The normal frontal QRS electrical axis gradually shifts left (upward) with age, showing a definite age trend. The physiological evolution of the QRS axis caused a significant age difference in the QRS wave amplitude of limb leads. Obviously, it is not appropriate to apply the same diagnostic criteria for left ventricular hypertrophy to different age groups.