P波离散度对甲状腺功能亢进患者心房颤动的预测意义

目的探讨甲状腺功能亢进患者阵发性心房颤动（PAF）的预测因子及其预测价值。方法67例甲亢患者，分为观察组（35例，合并阵发性心房颤动患者）和对照组（32例，单纯甲亢患者）。两组均在窦性心律时以多导电生理记录仪测最大P波间期（Pmax）、最小P波间期（Pmin）和P波离散度（Pd）；以多普勒超声诊断仪测左房内径（LAD）和左室射血分数（LVEF）。结果观察组年龄（49．8±10．7VS44．3±9．5岁，p〈0．05）、左房内径（35．2±3．6VS32．9±2．9mm，p〈0．01）、Pmax（114．6±7．6VS105．4±9．2ms，P〈0．001）和Pd（45．4±8．2VS33．4±7．3ms，P〈0．001）均明显大于对照组。两组性别构成、心率、LVEF、血清游离T3（FT3）、游离T4（FT4）、促甲状腺激素（TSH）及Pmin未见统计学差异。单变量logistic回归分析显示年龄、左房内径、Pmax、Pd为阵发性心房颤动的预测因子。多变量logistic回归分析显示只有Pd为阵发性心房颤动的独立预测因子（p=0．000）。以Pd≥37．5ms为切点值预测阵发性心房颤动的敏感性为91．4％，特异性为68．7％，阳性预测准确率为76．2％。结论P波离散度增大可作为甲亢患者阵发性心房颤动发生风险的独立预测因子，Pd≥37．5ms可作为甲亢患者阵发性心房颤动预测的切点值。

The stgnificance of P-wave dispersion for the prediction of paroxysmal atrial fibrillation in the patients with hyperthyroidism

Objective To evaluate the predictor of paroxysmal atrial fibrillation （PAF） in the patients with hyperthyroidism. Methods 67 patients with overt hyperthyroidism were divided into 2 groups： observed group （35 patients with hyperthyroidism and documented PAF） and controlled group （32 patients with hyperthyroidism）. The maximum P-wave duration （Pmax）, the minimum P-wave duration （Pmin） and P-wave dispersion （Pd） were mea- sured by multi-channel electrophysiological recorder. Left atrial diameter （LAD） and left ventricular ejection fraction （LVEF） were assessed by Doppler echocardiogram. All parameters above were surveyed only under the condition of sinus rhythm. Results Age （49.8 ± 10.7 vs 44.3 ± 9.5 years,p〈0.05）, LAD （35.2 ± 3.6 vs 32.9 ± 2.9 mmp〈0.01）, Pmax （114.6 ± 7.6 vs 105.4 ± 9.2 ms,p〈0.001）and Pd （45.4 ± 8.2 vs 33.4 ± 7.3 ms, p〈0.001） in observed group were significantly higher than controlled group, while sex, heart rate, LVEF, Pmin, serum free T3 （FT3）, free T4 （FT4）, and TSH levels had no statistical difference between the two groups. Univariate logistic re- gression analysis showed that age, LAD, Pmax and Pd were significant predictors of PAF, but multivariate logistic regression analysis revealed that only Pd was significant independent predictor of PAF （p= 0.000）. The Pd ≥37.5 ms served as a cut-off point of PAF prediction witha sensitivity of 91.4%, specificity of 68.7%, and positive predictive accuracy of 76.2%. Conclusions The higher Pd with a cut-off point of 37.5 ms may be served as an independent predictor of PAF occurrence.