心电图在肺栓塞严重程度评估中的应用研究

目的:探讨心电图(ECG)和21-Daniel ECG评分在肺血栓栓塞症(PTE)严重程度评估中的应用价值。方法:选择2005年1月～2009年7月江苏省人民医院收治的251例确诊的PTE患者,分析入院48h内的标准12导联ECG,按照Daniel ECG评分系统计算得分。评价ECG波形、Daniel ECG分值与危险分层、临床预后及肺动脉收缩压(SPAP)的关系,并使用ROC曲线评估ECG分值预测高危PTE、预后不良PTE、SPAP≥50 mmHg的准确性。结果:251例PTE患者中ECG出现异常者占82.9%,其中最多见波形为胸前导联T波倒置。Daniel ECG评分中位数为3分。与各自对照组相比,高危组、预后不良组和SPAP≥50mmHg组ECG评分均显著增高(P<0.01)。在ROC曲线分析中,Daniel ECG评分预测高危PTE和SPAP≥50mmHg的准确性的曲线下面积(AUC)分别为0.721和0.764,两者准确性均为中等水平。以3.5分为诊断界点,对高危PTE阴性预测值为92.4%;以10.5分为诊断界点,预测高危PTE、预后不良及SPAP≥50 mmHg的特异度分别为92.6%、92.5%、94.0%。结论:ECG和Daniel ECG评分与PTE的病情严重程度有较好的相关性,Daniel ECG评分对PTE的严重程度有较好的预测价值。

Clinical value of the electrocardiogram in evaluating the severity of pulmonary embolism

Objective:To study the clinical value of electrocardiogram(ECG) and 21-Daniel ECG in evaluating the severity of pulmonary thromboembolism(PTE).Methods:A total of 251 patients diagnosed as PTE in Jiangsu Provincial People′s Hospital from January 2005 to July 2009 were enrolled in this study.The 12-lead ECGs of the first 48 hours after hospitalization were analyzed and scores were calculated according to the 21-Daniel ECG scoring system.The relationship between ECG waveform,Daniel ECG scores and risk of stratification,clinical prognosis and systolic pulmonary artery pressure(SPAP) were evaluated.Moreover,receiver operator characteristic(ROC) curve was taken to assess the accuracy of ECG score in predicting the high-risk of PTE,unfavorable prognosis of PTE and SPAP≥50 mmHg.Results: ECG abnormalities accounted for 82.9% of the 251 patients,the most common waveform were T-wave inversion in pre-cordial-lead and the median of Daniel ECG scores was 3 points.Comparing with their respective control group,the ECG scores of high-risk group,the unfavourable prognosis group and SPAP(≥ 50 mmHg) group were significantly increased(P<0.01).The area under the curve of ROC,which in evaluating the accuracy of high-risk PTE and SPAP(≥50 mmHg),were 0.721 and 0.764 respectively.The accuracy were both in medium range.Based on ROC curves,with a cut-off value of 3.5 points,the negative predictive values for high-risk PTE were 92.4%,and with a cut-off value of 10.5 points,the specificity for predicting high-risk PTE,unfavourable prognosis PTE and SPAP(≥50mmHg) were 92.6%,92.5%,94.0% respectively.Conclusions: Both ECG and 21-Daniel ECG were associated with the severity of PTE.However,21-ECG score is simpler and cheaper,and is valuable for predicting severity of PTE.