Page 50 - 第10期

南京医科大学学报（自然科学版） 第41卷第10期
·1468 · Journal of Nanjing Medical University（Natural Sciences） 2021年10月

·临床医学·

微伏级T波电交替在低中危冠心病患者的应用

卞燕飞 ，颜紫宁 ，葛少洁 1
2*
1
南京医科大学附属常州第二人民医院心功能科，心内科，江苏 常州 213003
1 2

［摘 要］ 目的：分析低危、中危冠心病患者的微伏级T波电交替（microvolt T⁃wave alternans，MTWA）值与最大微伏级T波电
交替（max⁃MTWA）值并评估低、中危冠心病患者猝死风险的差异。方法：选取确诊的冠心病患者112例作为冠心病组，非冠心
病患者66例作为对照组，冠心病组再根据运动平板试验Duke评分（Duke treadmill score，DTS）分为两个亚组，即低危组（5分≤
DTS≤15分）和中危组（-10分≤DTS＜5分）。所有研究对象进行运动平板试验的同时用移动平均修正法测得max⁃MTWA值及
其对应的心率（heart rate，HR）和 MTWA 值，计算 max⁃MTWA 值及其对应 HR 的比值（max⁃MTWA/HR），并比较各组患者 max⁃
MTWA值、max⁃MTWA/HR比值和MTWA值的差异。结果：冠心病组的max⁃MTWA值、max⁃MTWA/HR比值和MTWA值较对照
组高，差异有统计学意义（P均＜0.05），且max⁃MTWA值及max⁃MTWA/HR比值中危组＞低危组＞对照组，差异均具有统计学
意义（P均＜0.05）。对照组与低危组MTWA值的差异无统计学意义（P＞0.05）。中危组的MTWA值明显高于对照组和低危组
（P均＜0.05）。结论：冠心病严重者max⁃MTWA值及max⁃MTWA/HR比值升高。低危冠心病患者猝死风险较低，与对照人群无
差异，而中危冠心病患者猝死风险较低危冠心病患者高。
［关键词］ 运动平板试验；冠心病；微伏级TWA值；最大微伏级TWA值；心脏性猝死
［中图分类号］ R541.4 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）10⁃1468⁃06
doi：10.7655/NYDXBNS20211008

The application of microvolt T ⁃ wave alternans in patients with low and moderate risk
coronary artery disease

1
2*
BIAN Yanfei ，YAN Zining ，GE Shaojie 1
Department of Cardiac Function，Department of Cardiology，the Affiliated Changzhou No.2 People′ s Hospital of
1 2
Nanjing Medical University，Changzhou 213003，China

［Abstract］ Objective： To analysis the values of microvolt T⁃wave alternans（MTWA）and maximum T⁃wave alternans（max⁃MTWA）
in patients with low or moderate risk coronary artery disease（CAD），and assess the risk of sudden cardiac death（SCD）. Methods： One
hundred and twelve CAD patients were enrolled for this study，and sixty⁃six non⁃CAD patients as the control group. Based on the Duke
treadmill test scores（DTS），CAD patients were divided into 2 groups：the low⁃risk CAD group（with scores ranging from 5 to 15）and
the moderate⁃risk CAD group（with scores ranging from⁃10 to 5）. All participants performed treadmill exercise stress tests and MTWA，
max⁃MTWA and the heart rates（HR）at max⁃MTWA were recorded by the time⁃domain modified moving average beat analysis（MMA）
method，then the ratio of max⁃MTWA/HR was calculated. Results： There were significant differences in max⁃MTWA，max⁃MTWA/HR
ratio and MTWA values between the control group and the CAD group（all P＜0.05）. Furthermore，subgroup analysis showed that the
max⁃MTWA and max⁃MTWA/HR ratio in the moderate⁃risk CAD group were higher than those in the low⁃risk CAD group，and the
parameters in the low⁃risk CAD group were higher than those in the control group（all P＜0.05）. There was no significant difference in
MTWA between the low⁃risk CAD group and the control group（P＞0.05）. However，MTWA in the moderate⁃risk CAD group were
significantly higher than those in the low⁃risk CAD group and the control group（all P＜0.05）. Conclusion： max⁃MTWA and max⁃
MTWA/HR ratio were significantly increased in patients with severe CAD. The risk of SCD in low⁃risk CAD patients was the low as the
control group，while moderate⁃risk CAD patients have a higher risk of SCD.

［基金项目］ 常州市卫生计生委重大科技项目（ZD201605）
∗
通信作者（Corresponding author），E⁃mail： nz_y@sina.com