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目的探讨运动前及运动峰值Tp-Te间期、Tp-Te/QT、Tp-Te/QTc、Tp-Te/姨RR值等参数能否提高心电图活动平板的阳性预测值。方法以2006年1月至2014年5月既往无冠心病病史、而因胸痛就诊于温州医科大学附属第一医院的698例患者为研究对象,其中,心电图平板运动试验结果阳性且行冠脉造影的患者157例,男性109例,女性48例,分别测量并计算运动前及运动峰值时Tp-Te间期、Tp-Te/QT、Tp-Te/QTc及Tp-Te/姨RR值等。根据冠状动脉造影结果分为造影阴性组和冠脉造影阳性组。分析两组之间运动前及运动峰值QT间期、QTc间期、Tp-Te间期、Tp-Te/QT、Tp-Te/QTc及Tp-Te/姨RR值等参数的变化情况。应用SPPP 16.0统计软件进行数据分析。结果运动前Tp-Te/QT、Tp-Te/姨RR和运动峰值Tp-Te、Tp-Te/QT、Tp-Te/QTc、Tp-Te/姨RR、Duke积分、Tp-Te差值和Tp-Te/姨RR差值在造影阳性组与阴性组间比较,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,运动峰值Tp-Te间期(OR=0.02,95%CI:0.01~0.49)、运动峰值Tp-Te/QT(OR=13.64,95%CI:1.64~103.19)、Tp-Te/QTc(OR=9.21,95%CI:1.98~68.24)、Tp-Te/姨RR(OR=7.56,95%CI:1.07~53.29)、Tp-Te/姨RR差值(OR=9.17,95%CI:1.31~64.26)与造影结果相关(P<0.05),各参数均有较高的敏感性和特异性。结论运动峰值时的Tp-Te间期、Tp-Te/QT、Tp-Te/QTc、Tp-Te/姨RR和Tp-Te/姨RR差值及其变化结合传统诊断标准,可提高运动平板试验的阳性预测值。
Objective To investigate whether pre-exercise and exercise peak Tp-Te interval, Tp-Te / QT, Tp-Te / QTc and Tp-Te / RR can improve the positive predictive value of electrocardiogram activity plate. Methods From January 2006 to May 2014, there was no history of coronary heart disease in the past. However, 698 patients treated by chest pain in the First Affiliated Hospital of Wenzhou Medical University were studied. Among them, electrocardiogram treadmill test was positive and coronary angiography 157 patients, 109 males and 48 females. The Tp-Te interval, Tp-Te / QT, Tp-Te / QTc and Tp-Te / RR were measured before and during exercise. According to coronary angiography results were divided into contrast-negative group and coronary angiography-positive group. The changes of QT interval, QTc interval, Tp-Te interval, Tp-Te / QT, Tp-Te / QTc and Tp-Te / RR before exercise and before exercise were analyzed. Apply SPPP 16.0 statistical software for data analysis. Results Before exercise, Tp-Te / QT, Tp-Te / RR and peak Tp-Te, Tp-Te / QT, Tp-Te / QTc, Tp-Te / Tp-Te / aunt RR difference in the contrast between the positive group and negative group, the difference was statistically significant (P <0.05). Logistic regression analysis showed that there were significant differences in Tp-Te interval (OR = 0.02,95% CI: 0.01 ~ 0.49), peak Tp-Te / QT (OR = 13.64, 95% CI: 1.64 ~ 103.19) Tp-Te / QTc (OR = 9.21,95% CI: 1.98-68.24), Tp-Te / RR RR (OR = 7.56,95% CI: 1.07-53.29) 95% CI: 1.31 ~ 64.26) were correlated with angiographic findings (P <0.05). All parameters were highly sensitive and specific. Conclusions The difference of Tp-Te interval, Tp-Te / QT, Tp-Te / QTc, Tp-Te / aunt RR and Tp-Te / aunt RR during peak exercise and their changes combined with the traditional diagnostic criteria can improve the motor activity Test positive predictive value.