散点图与24 h动态心电图诊断恶性心律失常的价值

邓春云

【摘要】 目的：探究散點图与24 h动态心电图诊断恶性心律失常（MA）的价值。方法：回顾性分析2019年9月-2020年9月收治的86例急性心肌梗死（AMI）患者的相关资料，依据患者是否并发MA将患者分为AMI-MA组（n=46）以及AMI-NMA组（n=40），患者均接受24 h动态心电图检查，并应用散点图进行分析。比较两组患者24 h动态心电图相关指标，心电图散点图B线斜率以及图像形态比例。分析24 h动态心电图相关指标与散点图B线斜率对MA的诊断价值。结果：AMI-MA组患者24 h QTV、Day-QTV、Night-QTV、SDANN index、SDNN、RMSSD、SDNN index均显著低于AMI-NMA组（P<0.05）。AMI-MA组患者B线斜率和不规则形、扇形、三分布形、短棒状形、四分布形散点图形态比例均显著高于AMI-NMA组，而彗星状形散点图形态比例明显低于AMI-NMA组（P<0.05）。ROC曲线结果显示，24 h QTV、Day-QTV、Night-QTV、SDANN index、SDNN、RMSSD、SDNN index诊断MA的AUC分别为0.861、0.781、0.642、0.723、0.683、0.535、0.670，B线斜率诊断MA的AUC为0.930，B线斜率AUC值显著高于其他指标AUC值（P<0.05）。结论：散点图与24 h动态心电图可用于诊断MA，尤其是散点图中B线斜率对诊断MA病情价值相对较高。

【关键词】 散点图 24 h动态心电图 恶性心律失常

Value of Scatter Plots and 24 h Dynamic Electrocardiogram in the Diagnosis of Malignant Arrhythmia/DENG Chunyun. //Medical Innovation of China， 2021， 18（27）： 0-041

[Abstract] Objective： To explore the value of scatter plots and 24 h dynamic electrocardiogram in the diagnosis of malignant arrhythmia （MA）. Method： This study retrospectively analyzed the relevant data of 86 patients with acute myocardial infarction （AMI） between September 2019 and September 2020. The patients were divided into AMI-MA group （n=46） and AMI-NMA group （n=40） according to presence or absence of MA. All patients received 24 h dynamic electrocardiogram examination， and scatter plots were used for analysis. The 24 h dynamic electrocardiogram associated indicators， the slope of the B line on the scatter plot and the proportions of image shapes were compared between the two groups. The diagnostic value of 24 h dynamic electrocardiogram associated indicators and the slope of the B line on the scatter plot for MA was analyzed. Result： 24 h QTV， Day-QTV， Night-QTV， SDANN index， SDNN， RMSSD and SDNN index in AMI-MA group were significantly lower than those in AMI-NMA group （P<0.05）. The slope of B line and the proportions of irregular， fan-shaped， triaxial， short-bar and quadrilateral scatter plots in AMI-MA group were significantly higher than those in AMI-NMA group， while the proportion of comet-shaped scatter plots was significantly lower than that in AMI-NMA group （P<0.05）. ROC curve analysis showed that the AUC values of 24 h QTV， Day-QTV， Night-QTV， SDANN index， SDNN， RMSSD and SDNN index to diagnose MA were 0.861， 0.781， 0.642， 0.723， 0.683， 0.535 and 0.670， respectively. The AUC of the slope of B line for diagnosing MA was 0.930， which was significantly larger than AUC values of the other indexes （P<0.05）. Conclusion： Scatterplot and 24 h dynamic electrocardiogram can be used to diagnose MA， especially the slope of B line in scatterplot has relatively high value for diagnosis of MA.

[Key words] Scatter plots 24 h dynamic electrocardiogram Malignant arrhythmia

First-author’s address： The Third Hospital of Nanchang， Nanchang 330009， China

doi：10.3969/j.issn.1674-4985.2021.27.010

急性心肌梗死（acute myocardial infarction，AMI）是常见的患病率、残疾率以及死亡率均居高不下的心血管危重症，其发病具有进展快速、病情危急等特点，而恶性心律失常（malignant arrhythmia，MA）为AMI患者预后不佳的重要危险因素[1-3]。因此，有效筛选出AMI中MA患者对于改善患者预后，降低患者病亡率意义重大。常规心脏电生理检查虽然筛查灵敏度较高，但是因为其有创性使其应用受限，24 h动态心电图因其检查无创以及可以重复检查优势已被应用于筛查AMI合并MA患者[4]。心电散点图为采用计算机技术将心电检查中心脏节律变化采用散点形式展示在坐标系中，以便迅速对动态心电图进行分析[5]。……