下壁单、多导联病理性Q波对冠心病诊断价值比较

目的结合冠脉造影探讨下壁单、多导联病理性Q波在冠心病诊断中的诊断价值比较。方法158例疑诊冠心病患者行常规12导联ECG检查，并加做V3R、V4R、VSR导联及冠脉造影，进行心电图及冠脉造影比较。结果下壁单导联病理性Q波诊断冠心病灵敏度为12．9％、特异度68．6％、假阴性率（漏诊率）为77．1％假阳性率为31．4％、阳性预测值为42．1％、阴性预测值为30．8％。双导联病理性Q波诊断冠心病灵敏度为28．7％、特异度70．6％、假阴性率（漏诊率）为71．3％，假阳性率为28。4％、阳性预测值为68．8％。三导联Q波诊断冠心病灵敏度为31．6％、特异度85．7％、假阴性率（漏诊率）为68．4％假阳性率为14．3％、阳性预测值为86．1％。结论（1）下壁单双导联病理性Q波诊断冠心病灵敏度较低，单凭该标准诊断冠心病漏诊率较高，也有一定的误诊率（31．4％），也即我们通常所说的病理性Q波并不全代表心肌梗死，有些非心肌梗死却可出现酷似心肌梗死的图形，如左侧气胸、肺气肿、肺梗死、心肌炎、心肌病、束支传导阻滞、预激综合征、感染或休克、颅内病变等；（2）三导联Q波较单双导联Q波诊断冠心病特异度高．阳性预测价值更有意义。

Compared with clinical evaluation to diagnosis coronary heart disease in patients with single or poly acute Q-wave in inferior wall leads

Objective To compare the clinical evaluation to diagnosis coronary heart disease in patients with single or poly acute Q-wave changes in inferior wall leads in. Methods 158 patients who had been suspected coronary heart disease received coronary angiography and twelve normal leads electriccardjography ECG,andV3R,V4R,V5R leads.Results Sensitivity which diagnosis coronary heart disease in patients with single of acute Q-wave change in inferior wall leads was 12.9%,specificity was 68.6%,omission diagnostic rate was 77.1%,mistake diagnostic rate was 31.4%,positive predictive value was 42.1%,negative predictive value was 30.8%,sensitivity to diagnosis coronary heart disease in patients with pair ofacute Q-wave change in inferior wall leads disease was 28.7%,specificity was 70.6%,omission diagnostic rate was 71.3%,mistake diagnostic rate was 28.4%,positive predictive value was 68.8%,sensitivity to diagnosis coronary heart disease in patients with three ofacute Q-wave change in inferior wall leads was 31.6%,specificity was 85.7%,omission diagnostic rate was 68.4%,mistake diagnostic rate was 14.3%,positive predictive value was 86.1%. Conclusion 1.Sensitivity to diagnosis coronary heart disease in patients with single or pair ofacute Q-wave change in inferior wall leads is very low,omission diagnostic rate is high,mistake diagnostic rate is certain(46.67%),we used to say that Q-wave acute does not mean inferior wall myocardial infarction ,there are also some uninfarction deases can appear Q-wave as,myocarditis,left pneumothorax cardiomyopathy,pulmonary emphysema,pulmonary infaraction ,preexcitation syndrome,bundle branch block,infection or shock,diseases in brain and so on. 2. sensitivity which diagnosis coronary heart disease in patients with three ofacute Q-wave change in inferior wall leads is higher than those in single or pair ofacute Q-wave change,positive predictive value which diagnosis coronary heart disease in patients with three ofacute Q-wave change inferior wall leads seems more usefuler.