中国全科医学 ›› 2022, Vol. 25 ›› Issue (36): 4502-4508.DOI: 10.12114/j.issn.1007-9572.2022.0446

所属专题: 高血压最新文章合集 肥胖最新文章合集

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心电图新标准对高血压合并超重和肥胖人群左心室肥厚的诊断效能研究

杨涛1,2, 张永军2, 郑亮3, 葛许华1,4,*()   

  1. 1.200092 上海市,同济大学医学院全科医学系 同济大学附属杨浦医院全科医学科
    2.241001 安徽省芜湖市,皖南医学院第一附属医院 弋矶山医院 电生理科
    3.200120 上海市,同济大学医学院 同济大学附属东方医院上海市心衰研究所
    4.200090 上海市,上海市全科医学与社区卫生发展研究中心
  • 收稿日期:2022-04-20 修回日期:2022-07-10 出版日期:2022-12-20 发布日期:2022-09-08
  • 通讯作者: 葛许华
  • 杨涛,张永军,郑亮,等.心电图新标准对高血压合并超重和肥胖人群左心室肥厚的诊断效能研究[J].中国全科医学,2022,25(36):4502-4508. [www.chinagp.net]
    作者贡献:杨涛负责文献检索与整理,数据收集和整理,研究结果分析与解释,绘制图表,进行论文的初步撰写及修订;张永军负责提出选题方向,数据收集,研究设计与实施;郑亮负责设计研究方案与可行性分析,研究结果分析与解释,论文的修订;葛许华负责选题方向,论文的构思与设计,文章质量控制及审校,并对文章整体负责。
  • 基金资助:
    同济大学研究生医学教育管理专项项目(2021YXGL14); 上海市医药卫生发展基金会课题(SE1201933)

Diagnostic Efficacy of New ECG Criteria for Left Ventricular Hypertrophy in Overweight and Obese Patients with Hypertension

YANG Tao1,2, ZHANG Yongjun2, ZHENG Liang3, GE Xuhua1,4,*()   

  1. 1.Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200092, China
    2.Department of Electrophysiology, the First Affiliated Hospital of Wannan Medical College/Yijishan Hospital, Wuhu 241001, China
    3.Shanghai Heart Failure Institute, Dongfang Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai 200120, China
    4.Shanghai Research Center for General Practice and Community Health, Shanghai 200090, China
  • Received:2022-04-20 Revised:2022-07-10 Published:2022-12-20 Online:2022-09-08
  • Contact: GE Xuhua
  • About author:
    YANG T, ZHANG Y J, ZHENG L, et al. Diagnostic efficacy of new ECG criteria for left ventricular hypertrophy in overweight and obese patients with hypertension [J] . Chinese General Practice, 2022, 25 (36) : 4502-4508.

摘要: 背景 相较于传统电压标准,心电图(ECG)新标准对普通高血压人群诊断左心室肥厚(LVH)有着更高的准确性,但ECG新标准对超重和肥胖人群LVH的诊断效能鲜有报道。 目的 探讨ECG新标准对高血压合并超重和肥胖人群LVH的诊断价值。 方法 回顾性选取2017年12月至2020年12月在皖南医学院第一附属医院收治的高血压病合并超重和肥胖患者368例,以超声心动图(UCG)为金标准,将LVH>115 g/m2(男性),>95 g/m2(女性)设为LVH(+)组;LVH≤115 g/m2(男性),≤95 g/m2(女性)设为LVH(-)组。收集并比较两组患者一般资料、UCG指标〔舒张末期室间隔厚度(IVST)、舒张末期左心室后壁厚度(LVPWT)、左心室质量(LVM)、左心室体积指数(LVMI)、左心室射血分数(LVEF)〕及ECG指标〔QRS波群持续时间(QRSd)、校正QT间期(QTc)、Sokolow-Lyon电压、Cornell电压、Peguero Lo-Presti电压、Cornell乘积)〕。采用二分类Logistic回归模型分析高血压合并超重和肥胖人群LVH的影响因素,运用ROC曲线评价ECG新标准(Sokolow-Lyon电压、Cornell电压、Peguero Lo-Presti电压、Cornell乘积)对超重和肥胖人群LVH的诊断效能。 结果 LVH(-)组和LVH(+)组一般资料中的性别、年龄、体表面积(BSA)、收缩压(SBP)、舒张压(DBP)、β-受体阻滞剂使用率及血压控制情况比较,差异均有统计学意义(P<0.05)。LVH(+)组IVST、LVPWT、LVM、LVMI、QRSd、QTc、Sokolow-Lyon电压、Cornell电压、Peguero Lo-Presti电压、Cornell乘积均高于LVH(-)组,LVH(+)组LVEF低于LVH(-)组(P<0.05)。年龄〔OR=1.046,95%CI(1.024,1.069)〕、Sokolow-Lyon电压〔OR=1.793,95%CI(1.305,2.463)〕是高血压合并超重和肥胖人群患LVH风险的影响因素(P<0.05)。Sokolow-Lyon电压、Cornell电压、Peguero Lo-Presti电压、Cornell乘积诊断高血压合并超重和肥胖患者LVH的ROC曲线下面积(AUC)分别为0.674、0.695、0.662、0.722;以年龄、BSA、SBP、DBP、高血压病程时间、QRSd、QTc、Sokolow-Lyon电压、Cornell电压、Peguero Lo-Presti电压及Cornell乘积作为联合诊断模型,高血压合并超重和肥胖患者LVH的AUC为0.846。 结论 Sokolow-Lyon电压是高血压合并超重和肥胖人群患LVH风险的影响因素。ECG新标准Peguero Lo-Presti电压对高血压合并超重和肥胖人群LVH的诊断效能较低,不及Cornell乘积标准等传统心电图标准,联合诊断模型对超重和肥胖人群LVH具有更好的诊断性能,推荐在检查条件相对不足的基层推广使用。

关键词: 超重, 肥胖症, 高血压, 肥大,左心室, 心电描记术, 诊断

Abstract:

Background

The new electrocardiogram (ECG) criteria have higher accuracy in the diagnosis of left ventricular hypertrophy (LVH) in general population with hypertension than traditional ECG voltage criteria. However, the diagnostic efficacy of new ECG criteria for LVH in overweight and obese patients with hypertension has been rarely reported.

Objective

To explore the diagnostic value of new ECG indicators for LVH in overweight and obese patients with hypertension.

Methods

A retrospective design was used. A total of 368 overweight and obese patients with hypertension were recruited from the First Affiliated Hospital of Wannan Medical College from December 2017 to December 2020, and divided into LVH (+) group (including males with LVH>115 g/m2 and females with LVH >95 g/m2) and LVH (-) group (including males with LVH≤115 g/m2 and females with LVH≤95 g/m2) . General data were collected and compared between two groups. Intergroup comparison was also performed in terms of ultrasonic cardiography (UCG) indicators〔diastolic interventricular septal thickness (IVST) , left ventricular posterior wall thickness (LVPWT) , left ventricular mass (LVM) , left ventricular mass index (LVMI) , left ventricular ejection fraction (LVEF) 〕and ECG indicators〔QRS duration (QRSd) , corrected QT interval (QTc) , Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria, Cornell product〕with the accuracy of UCG indicators as the gold standard. Binary Logistic regression model was used to analyze the influencing factors of LVH in hypertension with overweight or obesity. ROC analysis was used to evaluate the diagnostic efficacy of new ECG indicators (Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria, Cornell product) for LVH in hypertension with overweight or obesity.

Results

There were statistically significant differences in sex ratio, mean age, body surface area (BSA) , SBP, DBP, β-blocker utilization rate and blood pressure control between LVH (+) and LVH (-) groups (P<0.05) . The mean values of IVST, LVPWT, LVM, LVMI, QRSd, QTc, Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria and Cornell product in LVH (+) group were higher than those in LVH (-) group (P<0.05) . The mean LVEF value in LVH (+) group was lower than that in LVH (-) group (P<0.05) . Age 〔OR=1.046, 95%CI (1.024, 1.069) 〕 and Sokolow-Lyon voltage criteria〔OR=1.793, 95%CI (1.305, 2.463) 〕 were influential factors for LVH risk in hypertension with overweight or obesity (P<0.05) . The AUC of Sokolow-Lyon voltage criteria, Cornell voltage criteria Peguero Lo-Presti voltage criteria and Cornell product for LVH diagnosis in hypertension with overweight or obesity was 0.674, 0.695, 0.662 and 0.722, respectively. The AUC of the combined diagnostic model with age, BSA, SBP, DBP, time of the duration of hypertension, QRSd, QTc, Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria, and Cornell product incorporated was 0.846.

Conclusion

In overweight and obese people with hypertension, the Sokolow-Lyon voltage criteria was associated with LVH. Moreover, the new ECG indicator Peguero Lo-Presti voltage criteria was less effective than Cornell product and other traditional ECG indicators in diagnosing LVH. The combined diagnostic model has proven to be with better diagnostic performance for LVH, which is recommended to be used and promoted in primary care settings with relatively unsatisfactory examination conditions.

Key words: Overweight, Obesity, Hypertension, Hypertrophy, left ventricular, Electrocardiography, Diagnosis