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目的:比较常规心电图(ECG)、动态心电图(AECG)采用Einthoven-Wilson12导联系统(A系统)和Mason-Likar12导联系统(B系统)记录时ST-T的差异。评价ECG、AECG采用不同导联系统对冠心病诊断的特异性,敏感性、误诊率、漏诊率。方法:选择207例行冠脉造影术(CAG)者为研究对象,其中CAG阳性者107例,CAG阴性者100例。均接受ECG、AECG检查,并分别采用A系统和B系统描记,每例4种描记方式在10min内完成。结果:(1)在ECG检查中,CAG阳性者,B系统与A系统相比,Ⅲ、V1～3的J点(以JⅢ、V1～3表示,以后类推)下移,STⅢ、aVR、V1～6下移,STⅠ上抬,TV2.4～6振幅降低,TⅠ、Ⅱ振幅升高;CAG阴性者,B系统与A系统相比,JⅡ、Ⅲ、aVF、V1下移,JaVR上抬,STⅡ、Ⅲ、V1、V3～4下移,TaVR、V4～5振幅降低。TⅡ振幅升高(2)在AECG检查中,CAG阳性者,B系统与A系统相比,JⅠ、Ⅲ、V1、V4～6下移,JaVR、aVL上抬,STⅢ、V1～2、V4～6下移,STⅠ、aVL上抬,TⅢ、5～6振幅降低,TⅠ、aVL振幅升高。CAG阴性者,B系统与A系统相比,JⅡ、aVF、V2、V6下移,JaVR上抬。STV1～2、V5～6下移,TaVR、V1～6振幅降低,TⅡ、aVF振幅升高。差异均有统计学意义,P<0.05。(3)不论ECG或AECG检查,采用B系统诊断冠心病较A系统误诊率增加。ECG检查中,采用A系统时,冠心病的误诊率为35.00%,漏诊率为36.45%;采用B系统诊断冠心病时,误诊率为46.00%,漏诊率为32.71%。在AECG检查中,采用A系统诊断冠心病时,误诊率为35.00%,漏诊率为35.51%;采用B系统诊断冠心病时,误诊率为47.00%,漏诊率为33.65%。结论:B系统记录的ST-T可能造成下壁、前壁心肌缺血的假象,在AECG诊断心肌缺血时应慎重,以免误诊,必要时应行CAG检查。
PURPOSE: To compare the differences of ST-T recorded by Einthoven-Wilson 12-lead system (A system) and Mason-Likar 12-lead system (B system) in conventional electrocardiogram (ECG) and ambulatory electrocardiogram (AECG). To evaluate the specificity, sensitivity, misdiagnosis rate and misdiagnosis rate of ECG and AECG in the diagnosis of coronary heart disease by different lead systems. Methods: A total of 207 patients undergoing coronary angiography (CAG) were selected as the study subjects, including 107 CAG positive patients and 100 CAG negative patients. All patients underwent ECG and AECG examinations. A and B systems were used for tracing. Four tracing methods were completed in 10 minutes. Results: (1) In CAG-positive patients, B system compared with A system, the J points of Ⅲ and V1 ~ 3 (represented by JⅢ and V1 ~ 3, Compared with A system, JⅡ, Ⅲ, aVF, V1 downwards and JaVR uplifted in B group compared with A group, the amplitude of TV Ⅱ.4 ~ 6 decreased and T Ⅰ, Ⅱ amplitude increased. ST Ⅱ, Ⅲ, V1, V3 ~ 4 down, TaVR, V4 ~ 5 amplitude decreased. (2) In AECG examination, CAG positive, B system compared with A system, JI, III, V1, V4-6 down, JaVR, aVL elevation, ST III, V1 ~ 2, V4 ~ 6 down, ST Ⅰ, aVL elevation, T Ⅲ, 5 ~ 6 amplitude decreased, T Ⅰ, aVL amplitude increased. CAG negative, B system compared with the A system, J Ⅱ, aVF, V2, V6 down, JaVR elevation. STV1 ~ 2, V5 ~ 6 down, TaVR, V1 ~ 6 amplitude decreased, T Ⅱ, aVF amplitude increased. The differences were statistically significant, P <0.05. (3) Regardless of ECG or AECG examination, using the B system to diagnose coronary heart disease than the A system misdiagnosis rate increased. In the ECG examination, when using A system, the rate of misdiagnosis of coronary heart disease was 35.00% and the rate of misdiagnosis was 36.45%. The misdiagnosis rate of coronary heart disease was 46.00% and the rate of misdiagnosis was 32.71%. In the AECG examination, when using the A system to diagnose coronary heart disease, the misdiagnosis rate was 35.00% and the rate of misdiagnosis was 35.51%. When using the B system to diagnose coronary heart disease, the misdiagnosis rate was 47.00% and the rate of misdiagnosis was 33.65%. CONCLUSIONS: ST-T recorded by system B may cause the illusion of inferior wall and anterior myocardial ischemia. AECG should be cautious when diagnosing myocardial ischemia to avoid misdiagnosis. CAG examination should be performed if necessary.