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目的:观察代谢综合征患者的P波时限及离散度(PWD)。方法:选择代谢综合征患者62(男34,女28)例,年龄(55±8)岁;非代谢综合征(对照)组58(男30,女28)例,年龄(55±9)岁。代谢综合征诊断标准:符合国际糖尿病联盟(IDF)代谢综合征定义。以中心性肥胖为基本条件(根据腰围判断),中国人群腹围确定主要基于中国上海市和香港的流行病学资料,男性≥90 cm,女性≥80 cm。所有患者进行12导联同步描记心电图。PWD是指体表心电图12导联中测定的P波最大时限与最小时限的差值。所有的受试者同时接受超声心动图检查。结果:代谢综合征组P波最大时限和PWD明显高于对照组[P波最大时限:(112±8)ms vs.(98±9)ms;PWD:(37±7)msvs.(23±5)ms,均P<0.01],而两组P波最小时限差异无显著意义。相关分析提示PWD与年龄、体质量指数、腰围、收缩压、舒张压、总胆固醇、三酰甘油呈正相关,而与高密度脂蛋白胆固醇呈负相关。进一步行多元线性回归分析表明,年龄(β=0.394,P<0.01)、体质量指数(β=0.22,P<0.01)、腰围(β=0.165,P<0.05)、收缩压(β=0.166,P=0.01)、总胆固醇(β=0.195,P<0.01)和三酰甘油(β=0.227,P<0.01)是PWD的独立危险因素。结论:代谢综合征组患者PWD明显高于对照组,提示P波离散度增加可能是代谢综合征患者房颤发生率增高的机制之一。
Objective: To observe the P wave duration and dispersion (PWD) in patients with metabolic syndrome. Methods: A total of 62 (34 males and 28 females) patients with metabolic syndrome (55 ± 8) years old and 58 (30 males and 28 females) non-metabolic syndrome patients (55 ± 9 years) . Metabolic syndrome diagnostic criteria: in line with the International Diabetes Federation (IDF) definition of metabolic syndrome. Based on central obesity (based on waist circumference), the Chinese population’s abdominal circumference was determined based on epidemiological data from Shanghai and Hong Kong, China, with males ≥90 cm and females ≥80 cm. All patients underwent 12-lead systolic electrocardiography. PWD is the difference between the maximum and minimum time limits for P-wave measured in the 12-lead ECG. All subjects underwent echocardiography at the same time. Results: The maximum duration of P wave and PWD in the metabolic syndrome group were significantly higher than those in the control group [maximum duration of P wave: (112 ± 8) ms vs. (98 ± 9) ms; PWD: (37 ± 7) ms vs. 5) ms, all P <0.01], while there was no significant difference between the two groups in the minimum duration of P wave. Correlation analysis showed that PWD was positively correlated with age, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride, but negatively correlated with high density lipoprotein cholesterol. Multiple linear regression analysis showed that age (β = 0.394, P <0.01), body mass index (β = 0.22, P <0.01) P = 0.01). Total cholesterol (β = 0.195, P <0.01) and triglyceride (β = 0.227, P <0.01) were independent risk factors for PWD. Conclusion: The PWD in patients with metabolic syndrome is significantly higher than that in the control group, suggesting that increased P wave dispersion may be one of the mechanisms of the increased incidence of atrial fibrillation in patients with metabolic syndrome.