摘要
目的探讨心电图R波递增不良(PRWP)对非缺血性与缺血性心脏疾病的鉴别价值。方法回顾性分析郑州大学第一附属医院心血管内科2022年8月至2025年5月收治198例心脏疾病的临床资料,根据心脏疾病是否缺血分为缺血性组(n=110)和非缺血性组(n=88)。收集两组患者的临床病例资料及心电图表现,分别采用Zema、Marquette、Depace、Warner标准判断PRWP阳性率,绘制受试者工作(ROC)曲线分析PRWP对缺血性心脏病的诊断效能。结果缺血性组在四种标准下PRWP阳性检出率均高于非缺血性组[Zema标准:40.00%vs 22.73%,P=0.010;Marquette标准:16.36%vs 3.41%,P=0.003;Depace标准:36.36%vs 15.91%,P=0.001;Warner标准:40.91%vs 11.36%,P<0.001];四个标准下,缺血性组在ST-T改变率(Zema:68.18%vs 9.10%;Marquette:78.18%vs 7.95%;Depace:70.91%vs 6.82%;Warner:74.55%vs 12.50%)、V1~V4导联异常率(Zema:63.64%vs 34.10%;Marquette:54.55%vs 27.27%;Depace:52.73%vs 18.18%;Warner:56.36%vs 26.14%)及V1~V3导联异常率(Zema:50.91%vs34.09%;Marquette:33.64%vs 15.91%;Depace:21.82%vs 7.95%;Warner:43.64%vs 25.00%)上均高于非缺血性组(P<0.05或P<0.001);Zema、Marquette、Depace、Warner标准诊断缺血性心脏病的AUC分别为0.628、0.567、0.630、0.668。结论心电图PRWP在鉴别缺血性与非缺血性心脏疾病中具有一定参考价值,但其诊断效能中等,需结合ST-T改变及V1~V4导联异常等特征进行综合判断。
Objective To explore the value of poor R-wave progression(PRWP)in electrocardiogram(ECG)for differentiating non-ischemic from ischemic heart disease.Methods The clinical data of 198 patients with heart disease admitted to the Department of Cardiovascular Medicine,the First Affiliated Hospital of Zhengzhou University from August 2022 to May 2025 were retrospectively analyzed.According to whether the heart disease was ischemic or not,the patients were divided into an ischemic group(n=110)and a non-ischemic group(n=88).Clinical case data and ECG manifestations were collected from both groups.PRWP positive rates were determined using the Zema,Marquette,Depace,and Warner criteria respectively.Receiver operating characteristic(ROC)curves were plotted to analyze the diagnostic efficacy of PRWP for ischemic heart disease.Results The positive detection rate of PRWP in the ischemic group was higher than that in the non-ischemic group under all four criteria:Zema criteria,40.00%vs 22.73%,P=0.010;Marquette criteria,16.36%vs 3.41%,P=0.003;Depace criteria,36.36%vs 15.91%,P=0.001;Warner criteria,40.91%vs11.36%,P<0.001.Under the four criteria,the rates of ST-T changes(Zema:68.18%vs 9.10%;Marquette:78.18%vs 7.95%;Depace:70.91%vs 6.82%;Warner:74.55%vs 12.50%),abnormalities in V1-V4 leads(Zema:63.64%vs 34.10%;Marquette:54.55%vs 27.27%;Depace:52.73%vs 18.18%;Warner:56.36%vs 26.14%),and abnormalities in V1-V3 leads(Zema:50.91%vs 34.09%;Marquette:33.64%vs 15.91%;Depace:21.82%vs 7.95%;Warner:43.64%vs 25.00%)in the ischemic group were all higher than those in the non-ischemic group(P<0.05 or P<0.001).The AUC values of the Zema,Marquette,Depace,and Warner criteria for diagnosing ischemic heart disease were 0.628,0.567,0.630,and 0.668,respectively.Conclusion ECG PRWP has certain reference value in differentiating ischemic from non-ischemic heart disease,but its diagnostic efficacy is moderate.Comprehensive judgment should be made by combining it with features such as ST-T changes and abnormalities in V1-V4 leads.
作者
焦天锐
舒娜
陈慧敏
郑孝文
JIAO Tian-rui;SHU Na;CHEN Hui-min;ZHENG Xiao-wen(Department of Functional Examination,the Ninth People's Hospital of Zhengzhou,Zhengzhou 450000,Henan,CHINA;Department of Cardiovascular Medicine,the Ninth People's Hospital of Zhengzhou,Zhengzhou 450000,Henan,CHINA;Department of Cardiovascular Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,CHINA)
出处
《海南医学》
2026年第5期663-667,共5页
Hainan Medical Journal
基金
河南省卫健委医学科技攻关项目(编号:LHGJ20200743)。
关键词
心电图
R波递增不良
缺血性心脏病
非缺血性心脏病
鉴别价值
Electrocardiogram
Poor R wave progression
Ischemic heart disease
Non-ischemic heart disease
Differential value
