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目的:探讨高血压患者的动态心电图(Holter),发作性ST段低压与室间隔(IVS)厚度之间的相关性。方法:收集2005年9月至2008年12月在本院住院共88例高血压患者,全部行超声心动图检查未见节段性室壁运动异常,并行冠脉计算机断层血管成像(CTA)未见冠脉狭窄或斑块,根据Holter上有无发作性ST段低压将患者分为2组,分析其与IVS厚度之间的相关性,并比较2组间IVS厚度的大小;然后以单因素及多因素分析筛选高血压患者发作性ST段低压的影响因素;建立受试者操作特征(ROC)曲线评估IVS厚度预测高血压患者有无发作性ST段低压的价值。结果:高血压患者Holter有无发作性压低与IVS厚度呈正相关(r=0.362,P=0.001),伴有发作性ST段压低组IVS厚度与无发作性ST段低压组相比差异有统计学意义(t=3.313,P=0.002);伴有IVS增厚的高血压患者有发作性ST段低压的发生率明显高于无IVS增厚的患者(x~2=9.694,P=0.002);多因素分析中只有IVS厚度与发作性ST段低压有相关性(OR=1.710,P=0.002);以IVS厚度预测高血压患者有无发作性ST段低压的ROC曲线下面积(AUC)为0.715±0.067,P=0.002,最佳分界值为10.5 mm,以IVS≥10.5 mm来预测有无发作性ST段压低,敏感性为59.3%,特异性为89.8%。结论:高血压患者IVS厚度与Holter上有无发作性ST段低压呈正相关;以IVS厚度预测高血压患者有无发作性ST低压的特异性较高,但敏感性较差。
Objective: To investigate the correlation between Holter, episodic ST-segment depression and IVS thickness in hypertensive patients. Methods: A total of 88 hospitalized patients with hypertension were collected in our hospital from September 2005 to December 2008. All patients underwent echocardiography with no segmental wall motion abnormalities. All patients underwent coronary artery computed tomography angiography (CTA) See the coronary stenosis or plaque, according to Holter with or without episodes of ST-segment depression, the patients were divided into two groups, analysis of its correlation with the thickness of IVS and compare the size of the IVS between the two groups; and then single-factor And multivariate analysis were used to screen the influencing factors of episodic ST-segment depression in hypertensive patients. The receiver operating characteristic (ROC) curve was constructed to evaluate the value of IVS thickness in predicting the presence or absence of episodic ST-segment depression in hypertensive patients. Results: There was a positive correlation between the severity of IVS and the severity of IVS in hypertensive patients (r = 0.362, P = 0.001). The difference of IVS between patients with and without ST-segment depression was statistically significant (T = 3.313, P = 0.002). The incidence of episodic ST segment depression was significantly higher in hypertensive patients with IVS thickened than those without IVS thickened (x 2 = 9.694, P = 0.002) In the multivariate analysis, only IVS thickness was correlated with episodic ST-segment depression (OR = 1.710, P = 0.002). The area under the ROC curve (AUC) of IVS thickness for predicting the presence or absence of episodic ST-segment depression in hypertensive patients was 0.715 ± 0.067, P = 0.002. The best cut-off value was 10.5 mm. The incidence of episodic ST-segment depression was predicted by IVS ≥10.5 mm, with a sensitivity of 59.3% and a specificity of 89.8%. Conclusions: There is a positive correlation between the IVS thickness and the presence or absence of episodic ST-segment depression in Holter. The IVS thickness has a high specificity in predicting the presence or absence of episodes of ST-ST in hypertensive patients, but the sensitivity is poor.