CAJ | 학술논문

目的：探讨前壁急性心肌梗死（AMI）伴高侧壁、下壁导联ST段变化预测左前降支（LAD）阻塞部位的准确率。方法：选取2010年6月-2013年12月井冈山大学附属医院心血管科145例前壁AMI患者伴高侧壁、下壁导联ST段变化辅助预测LAD阻塞部位与冠状动脉造影术（CAG）显示阻塞部位进行对比分析，以大对角支（LD）或第1对角支（D1）为界划分LAD为近、远段。结果：145例前壁AMI患者中40例（27.59%）STⅠ、aVL抬高>0.1 mV，42例（28.97%）STⅡ、Ⅲ、aVF压低≥0.1 mV。STⅠ、aVL抬高>0.1 mV判断阻塞部位在LAD之D1或LD开口近段的敏感性（54.90%vs 52.17%，P=0.757）、特异性（87.24% vs 94.74%，P=0.096），两者比较差异均无统计学意义（P>0.05）；阳性预测值[70.0%（28/40） vs 90.0%（36/40），P=0.025]比较差异有统计学意义（P<0.05）；以LD为界时LAD近段闭塞有较高的阳性预测值。STⅡ、Ⅲ、aVF下移≥0.1 mV判断阻塞部位在LAD之D1或LD近段的敏感性（58.82% vs 56.52%），两者比较差异无统计学意义（P=0.801）；特异性（87.24% vs 96.06%，P=0.044）、阳性预测值[71.43%（30/42） vs 92.86%（39/42）， P=0.010]，两者比较差异均有统计学意义（P<0.05），以LD为界时LAD近段闭塞有较高的特异性及阳性预测值。结论：高侧壁、下壁导联ST段变化对前降支阻塞部位的预测有重要的辅助作用。
목적：탐토전벽급성심기경사（AMI）반고측벽、하벽도련ST단변화예측좌전강지（LAD）조새부위적준학솔。방법：선취2010년6월-2013년12월정강산대학부속의원심혈관과145례전벽AMI환자반고측벽、하벽도련ST단변화보조예측LAD조새부위여관상동맥조영술（CAG）현시조새부위진행대비분석，이대대각지（LD）혹제1대각지（D1）위계화분LAD위근、원단。결과：145례전벽AMI환자중40례（27.59%）STⅠ、aVL태고>0.1 mV，42례（28.97%）STⅡ、Ⅲ、aVF압저≥0.1 mV。STⅠ、aVL태고>0.1 mV판단조새부위재LAD지D1혹LD개구근단적민감성（54.90%vs 52.17%，P=0.757）、특이성（87.24% vs 94.74%，P=0.096），량자비교차이균무통계학의의（P>0.05）；양성예측치[70.0%（28/40） vs 90.0%（36/40），P=0.025]비교차이유통계학의의（P<0.05）；이LD위계시LAD근단폐새유교고적양성예측치。STⅡ、Ⅲ、aVF하이≥0.1 mV판단조새부위재LAD지D1혹LD근단적민감성（58.82% vs 56.52%），량자비교차이무통계학의의（P=0.801）；특이성（87.24% vs 96.06%，P=0.044）、양성예측치[71.43%（30/42） vs 92.86%（39/42）， P=0.010]，량자비교차이균유통계학의의（P<0.05），이LD위계시LAD근단폐새유교고적특이성급양성예측치。결론：고측벽、하벽도련ST단변화대전강지조새부위적예측유중요적보조작용。
Objective: To explore the accuracy for electrocardiogram (ECG) prediction of left anterior descending artery (LAD) occlusion site in the anterior wall acute myocardial infarction (AMI) with high lateral and inferior leads ST-segment changes.Method: 145 patients with anterior wall AMI were selected in our hospital from June 2010 to December 2013.The ECG with high lateral and inferior leads ST-segment changes predicted the occlusion sites were compared with CAG showed in the cardiovascular department.The left anterior descending artery was divided into proximal and distal segment by the large diagonal(LD) or the first diagonal(D1).Result:In 145 patients of anterior wal AMI,40 cases(27.59%) with STⅠ,aVL elevation>0.1 mV,42 cases(28.97%) with STⅡ,Ⅲ,aVF depression≥0.1 mV.STⅠ,aVLelevation>0.1 mV judged the occlusion site in the recent opening of D1 or LD of the LAD, compared the two indexes of sensitivity (54.9% vs 52.17%,P=0.757) and specificity(87.24% vs 94.74%,P=0.096) of them, the differences were no statistically significant(P>0.05);in the positive predictive value of them [70.0%(28/40) vs 90.0%(36/40)], the difference was statistically significant(P=0.025), so as the LD boundary proximal LAD occlusion had a higher positive predictive value.STⅡ,Ⅲ,aVF depression≥0.1 mV judged the occlusion site in the recent opening of D1 or LD of the LAD,in the sensitivity of them (58.82% vs 56.52%),the difference was no statistically significant(P=0.801),in the specificity (87.24% vs 96.06%,P=0.044) and positive predictive value [71.43%(30/42) vs 92.86%(39/42),P=0.010] of them,the differences were statistically significant(P<0.05), so as the LD boundary proximal LAD occlusion had higher specificity and positive predictive value.Conclusion: An important supporting role is played in prediction of LAD occlusion site in the anterior wall AMI with high lateral and inferior leads ST-segment changes.