目的:评价十二导联常规心电图对冠脉缺血性心脏病的诊断与冠脉造影检查结果的一致性.方法:收集,对比2011年~2015年期间华北石油管理局总医院心内科109例行冠脉造影检查住院患者的术前常规十二导联心电图与其冠脉造影结果.将术前常规心电图结果按其具体表现分为:完全正常心电图;非特异性异常心电图(包括各种心律失常,非特异性ST-T改变)以及特异性改变心电图(包括异常Q波,典型ST抬高或压低,明显T波改变).冠脉造影结果按照冠脉斑块阻塞程度也分为三组:冠脉斑块阻塞小于50%;冠脉斑块阻塞50%~75%;冠脉斑块阻塞大于75%.对数据进行汇总,并做一致性分析统计.结果:109例中,常规心电图为完全正常窦性心律的有17例,非特异性异常心电图(包括心律失常11例,非特异性ST-T改变9例)20例,特异性改变心电图(包括异常Q波10例,ST-T改变40例,单纯ST压低12例,单纯T波倒置10例)72例;冠脉造影结果无斑块及阻塞小于50%共19例,冠脉斑块阻塞50%~75%的共11例,冠脉斑块阻塞大于75%的共79例.经分析后得出,两种检查结果有相关性(卡方 = 40.7520,P = 0.0000),可以用Kappa指数描述其一致性.Kappa指数 = 0.286195,说明此两种检查的一致性较差.结论:常规十二导联心电图是诊断冠脉缺血性心脏病的重要方法,但由于受采集时机等因素影响,其表现与实际冠脉病变程度一致性较差,不能单纯依此作为判断冠状动脉狭窄程度的依据,需要通过运动实验,24小时动态心电监测等检查来提高检测的敏感度和准确率.Aims: To analyze the consistency between coronary arteriography and electrocardiogram in ischemic heart disease. Methods: Between 2011 and 2015, 109 patients who received both arteriography and electrocardiogram in Cardiology Department, Huabei Petroleum General Hospital, were registered. We divided arteriography results into 3 groups by the degree of stenosis of coronary artery as 75%. The similar division was made in electrocardiogram results into 3 groups as normal, nonspecific abnormal and specific abnormal too. Results: In electrocardiogram teams, 17 patients were enrolled in normal group; 20 were nonspecific abnormal and the last 72 were specific abnormal. When it came to the arteriography teams, 19 were the degree of stenosis of coronary artery 75%. Kaplan-Meier analyses revealed that the very two methods results did have consistency (Kappa = 40.7520, p = 0.0000). However the Kappa index was 0.286195. That means the correlation between the two methods was poor. Conclusion: The electrocardiogram was important in detecting ischemic heart disease. However, under influence of many factors including the collecting time, the results of electrocardiogram was poor correlated with the real condition of coronary artery. We cannot simply diagnosis ischemic heart disease by the abnormal electrocardiogram alone. Combining with exercise test and 24 hour Holter monitoring, electrocardiogram can be more sensitive and accurate.
