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目的探讨ST段压低在急性左主干病变中的诊断价值。方法选取2000年1月～2007年3月间因急性心肌梗死住院的患者134例,经冠状动脉造影证实其中16例左主干病变(LMCA组)、85例前降支病变(LAD组)和33例右冠状动脉病变(RCA组)。患者入院即刻描记12导联心电图,分析各组患者ST段压低情况。结果单因素分析发现,II、III、aVF和V2～V6导联ST段压低在LAD和LMCA组间差异有统计学意义,II、III、aVL、aVF、V2和V6导联ST段压低在LMCA和RCA组间比较,差异有统计学意义。多因素判别分析结果表明,与LAD组相比,II、aVF和V2导联ST段压低对左主干病变有良好的诊断价值,敏感性31.3%,特异性可达98.8%,阳性预测价值83.3%;与RCA组相比时,aVF和V6导联ST段压低亦有良好的预测价值,敏感性62.5%,特异性和阳性预测价值均为100%。结论12导联心电图ST段压低在急性左主干病变诊断中有较高的特异性和阳性预测价值。
Objective To investigate the diagnostic value of ST segment depression in acute left main trunk disease. Methods Totally 134 patients hospitalized for acute myocardial infarction from January 2000 to March 2007 were selected. Among them, 16 cases of LMCA, 85 cases of LAD and 33 cases of LAD were confirmed by coronary angiography. Right coronary artery disease (RCA group). Patients admitted immediately recorded 12 lead electrocardiogram, analysis of ST-segment depression in each group. Results Univariate analysis showed that the ST segment depression in lead II, III, aVF and V2 ~ V6 was statistically different between LAD and LMCA group. The ST segment depression in lead II, III, aVL, aVF, V2 and V6 was lower in LMCA Compared with RCA group, the difference was statistically significant. Multivariate discriminant analysis showed that compared with LAD group, ST segment depression of leads II, aVF and V2 had a good diagnostic value for left main disease with a sensitivity of 31.3%, a specificity of 98.8% and a positive predictive value of 83.3% Compared with RCA group, ST segment depression of aVF and V6 lead also had good predictive value, with a sensitivity of 62.5% and a specificity and positive predictive value of 100%. Conclusion ST-segment depression of 12-lead electrocardiogram has high specificity and positive predictive value in the diagnosis of acute left main trunk disease.