临床心电学杂志2007年08月第16卷第4期临床心电学杂志2007年08月第16卷第4期肥厚型心肌病是临床常见的有遗传倾向的心肌病,部分可发生心脏性猝死。本文旨在探讨不同类型肥厚型心肌病的心电图特点。资料和方法肥厚型心肌病患者心电图分析张鸿丽**张海澄*周北玲**银鹏飞**黄永杰**张萍*郭继鸿*【摘要】目的探讨肥厚型心肌病住院患者的心电图特点。方法对1994年5月~2005年7月北京大学人民医院和北京世纪坛医院收治的经超声心动图诊断为肥厚型心肌病的住院患者76例,分析其心电图特点。结果按肥厚的部位分为单纯室间隔肥厚或室间隔肥厚为主组(46例)、单纯心尖肥厚组(14例)、单纯游离壁肥厚组(6例)和弥漫性肥厚组(10例)。间隔肥厚为主组患者中,23例(50.0%)存在病理性Q波,其中间隔厚度超过2.0cm者10例(42.5%);而在另23例无病理性Q波患者,间隔厚度超过2.0cm者仅5例(21.7%)。心尖肥厚组和单纯游离壁肥厚组均仅1例心电图存在病理性Q波。QRS波群宽度在各组无显著性差异(p>0.05)。76例患者中,心电图符合左室肥厚(SV1+RV5≥4.0mV)诊断标准的23例(30.3%),符合RV4>RV5>RV6(或RV3>RV4>RV5)者34例(44.7%),ST-T改变共71例(93.4%),ST段下移超过0.1mV者53例(69.7%),T波深倒置振幅超过0.5mV者30例(39.5%)。T波深倒置在心尖肥厚组多于间隔肥厚组(P=0.02),但T波倒置深度与心尖肥厚程度无明显相关(p=0.40)。间隔肥厚为主组中梗阻型和非梗阻型各项心电图指标无显著性差异(p>0.05)。结论病理性Q波多出现在室间隔肥厚为主型患者,T波深倒置在心尖肥厚组多于间隔肥厚组,但T波倒置深度与心尖肥厚程度无明显相关。【关键词】肥厚型心肌病;超声心动图;心电图[中图分类号]R542.2R540.1[文献标识码]A[文章编号]1005-0272(2007)04-253-03TheanalysisofelectrocardiograminpatientswithhypertrophiccardiomyopathyZhangHongli,ZhangHaicheng,ZhouBeiling,etal.BeijingShijitanHospital,Beijing,100038【Abstract】ObjectiveThepurposeofthisstudyistoanalyzeelectrocardiogramcharacteristicsofhyper-trophiccardiomyopathy.MethodsSeventy-sixin-patientswithhypertrophiccardiomyopathy(HCM)wereen-rolled.ThediagnosisofHCMwasbasedon2-dimensionalechocardiography.The12leadselectrocardiogramcharacteristicswereanalyzedcomparingwithechocardiography.ResultsThesepatientsweredividedintofourgroupsbyechocardiography:thesoleormainseptalhypertrophy(46cases),singleapicalhypertrophy(14cases),singleLVfreewallhypertrophy(6cases)andglobalhypertrophy(10cases).Twenty-threecasesofseptalhyper-trophy(50%)hadpathologicalQwavesandthemaximumventricularwallthicknessexceeded2.0cm(42.5%)intenofthem.Inaddition,therewereonly5cases(21.7%)thatthemaximumventricularwallthicknessexceeded2.0cminthosewhohadnopathologicalQwaves(p=0.116).SeptalhypertrophygroupandsingleLVfreewallhy-pertrophygroupbothhadonly1casewithpathologicalQwave.ThereisnosignificantdifferenceinwidthofQRScomplexamongfourgroups(p>0.05).Among76cases,appearanceofSV1+RV5≥4.0mVseenin23cases(30.3%),RV4>RV5>RV6(orRV3>RV4>RV5)in34(44.7%),STsegmentandTwavechanges71cases(93.4%),GiantnegativeTwavesexceeding0.5mV30cases(39.5%),whilethereisnosignificantrelationshipbetweenthedepthofnegativeTwaveandthemaximumapicalthickness(p=0.40).Therewerenodifferenceincliniccharacteris-ticsandparametersofelectrocardiogrambetweenthegroupofLVoutflowobstructionandnoobstructioninseptalhypertrophygroup.ConclusionPathologicalQwaveusuallywasseeninseptalhypertrophygroup,anddeepnegativeTwavesweremuchcommoninapicalhypertrophygroupbutthereisnosignificantrelationshipwiththemaximumapicalthickness.【Keywords】hypertrophiccardiomyopathy;echocardiography;electrocardiogram·临床研究·通讯作者:张海澄作者单位:*北京大学人民医院心内科(100044)**北京世纪坛医院干部保健科(100038)253··JCli...
