Abstract O bjective: To evaluate the diagnostic value of 12 - lead Holter in the coronary heart disease ( CHD ). M ethods: 47 inpatients from cardiovascular ward who had been diagnosed as sus2 cep tible CAD were selected. They were exam ined by CA G, 12 - lead Holter and 2 - dimension echo2 cardiography . The duration of the three exam inations was less than one week . Based on coronary an2 giography , the results of and the ST - segment data of 12 - lead Horter were analysed . Results: ( 1) The positive rate of the three methods (CA G, 12 - lead Holter, echocardiography ) in the diagnosis of CAD were 90. 6% , 64. 7% and 47. 3% respectively . ( 2) The sensitivity and specificity of 12 lead Holter in the diagnosis of CAD were 71. 43% and 60% respectively . The positive rate of 12 lead Holte in singe - vessle CAD group and multi - vessle CAD group were 68. 96% and 76. 92% respectively . There was no significant difference between the two group s (p > 0. 05). The sensitivity and specificity of echocardiography in the diagnosis of CAD were 52. 38% and 100% respectively . The positive rate of echocardiography in singe - vessle CAD group and multi - vessle CAD group were31. 03% and 100% respectively . There were significant difference between singe - vessle CAD group and multi - vessle CAD group (p < 0. 05) . ( 3) The results of 12 - lead Holter also show that the more serious the degree of the coronary stenosis was, the greater the range of ST - segment de2
2 结 果 2. 1 47例患者中 , CAG、12导 Holter及 2DE的阳性 检出率见表 1, 12导 Holter与 CAG检查的结果比较 见表 2, 2DE与 CAG检查的结果比较见表 3。
表 1 三种方法结果比较
例数 阳性 阴性
检出率
CA G
47 42 5
12 导 Hol2
47 30 17
无显著性 。
牡丹江医学院学报 2005年 第 26卷 第 4期 JOURNAL OF MUDANJ IANG MED ICAL COLLEGE Vol. 26 NO. 4 2005
·13·
组别
例数

多支病变组
13
合 计
47
表 4 12导 Holter与 CAG病变支数结果比较
·12·
牡丹江医学院学报 2005年 第 26卷 第 4期 JOURNAL OF MUDANJ IANG MED ICAL COLLEGE Vol. 26 NO. 4 2005
p ression was , the longer the ST - segment dep ression continued , the higher the positive rate of ar2 rhythm ia was and the more obvious the frequency and comp lexity of the arrhythm ia was . Conclu2 sion : The sensitivity of 12 - lead Holter in the diagnosis of CAD is higher, the cost is low and it is also an effective non - invasive method, so 12 - lead Holter can be a basic method in the diagnosis of CAD in the clinical p ractice . Key words 12 - lead Holter ; coronary heart disease ; coronary angiography ; echocardiography
THE UAL UE O F 12 - L EAD HOL TER IN THE D IAGNO S IS O F CO RO NARY HEART D ISEASE
Lv ning et al. The Heart D isease Center of Chuiyangliu Hosp ital in Beijing 100022
te r
2D E
47 22 25
90. 6% 64. 7% 47. 3%
表 2 12导 Holter与 CAG检查的结果比较
12导 Holter
CA G
CAG组 ( + )
CAG组 ( - )
( +)
30
2
(-)
12
3
42
5
12导 Holter对 CHD 诊断的敏感性是 71. 43% ( 30 /42) , 特异性是 60% (3 /5)
摘要 目的 :评价 12导联动态心电图 ( 12导 Holter)对冠心病 ( CHD )的诊断价值 。方法 :选择 47例拟诊为 冠心病的心内科住院患者 。同期内 (间隔 ≤1周 )分别接受冠状动脉造影 (CAG) 、12导 Holter及二维多谱勒 心脏超声心动图 (2DE)检查 ,以 CAG作为对照 ,以心超结果作为参考对 12导 HolterST段进行分析 。结果 : (1)三种方法检出率分别为 90. 6% , 64. 7% , 47. 3% 。 (2) 12导 Holter诊断冠心病的敏感性 、特异性分别为 71. 43% , 60%。对单支病变组 、多支病变组检出率分别为 68. 96% , 76. 92%。单支组与多支组检出率比较 差异无显著性 (p > 0. 05) ;心超诊断冠心病的敏感性 、特异性分别为 52. 38% , 100% ;对单支病变组 、多支病 变组检出率分别为 31. 03% , 100% ,单支组与多支组检出率比较有统计学意义 (p < 0. 05) 。 ( 3) 12导 Holter 检测结果还表明冠脉狭窄程度越重 ST段下移程度越大 ,持续时间越长 ,心律失常检出率越高 ,且心律失常频 度及复杂性越明显 。结论 : 12导 Holter对冠心病的诊断具较高的敏感性 ,且无创 、费用低 ,可作为冠心病诊断 的基本方法 。 关键词 动态心电图 ;冠状动脉造影 ;心脏超声心动图 ;冠心病 中图分类号 R681. 55 文件标识码 A
牡丹江医学院学报 2005年 第 26卷 第 4期 JOURNAL OF MUDANJ IANG MED ICAL COLLEGE Vol. 26 NO. 4 2005
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12导联动态心电图对冠心病的诊断价值
吕 宁 李 莉 李瑞杰 北京市垂杨柳医院心脏中心 100022
12导 Holter
阳性
阴性
2D E
阳性
阴性
12导 Holter 检出率
2
3
0
5
20
9
9
20
68. 96%
10
3
13
0
76. 92%
32
15
22
25
p > 0. 05
2D E 检出率
31. 03% 100%
p < 0. 05
2. 3 被 12导 Holter检出同时经 CAG证实为 CHD 的 30例患者其 ST段下移程度 、持续时间与冠脉狭 窄程度的关系见表 5,经 t检验 , ST段下移程度 、持 续时间与冠脉狭窄程度组差异有显著性 。单支病变 组 20例患者中检出心律失常 15例均为单纯性偶发 性心律失常 ,而多支病变组 10例患者中检出心律失 常 8例 ,多为混合性频发性心律失常 ,如室性早搏 、 室上性心动过速及房性早搏同时并存 。个别三支病 变组检出恶性心律失常如成对室性早搏 、短阵室速 等。
表 3 2DE与 CAG检查的结果比较
CA G
2D E
CAG组 ( + )
CAG组 ( - )
( +)
22
0
(-)
20
5
42
5
注 : 2DE 对 CHD 诊断的敏感性是 52. 38% , 特异性是 100%
2. 2 12导 Holter对单支 、多支病变的检出能力见 表 4, 2DE多支病变组与单支病变组检出率经统计 学分析比较 ,差异有统计学意义 。 12导 Holter多支 病变组与单支病变组检出率经统计学分析比较差异