动态心电图衍生的虚拟平面QRS波群和T波向量在糖尿病患者与非糖尿病患者中的变化
Changes of Virtual Planar QRS and T Vectors Derived from Holter in the Populations with and without Diabetes Mellitus.
作者信息
Chen Jia, Lin Yubi, Yu Jian, Chen Wanqun, Xu Zhe, Yang Zhenzhen, Zeng Chuqian, Li Wenfeng, Lai Xiaoshu, Lu Qiji, Zhou Jingwen, Tian Bixia, Xu Jing, Lin Yanping, Du Zuoyi, Zhang Aidong
机构信息
First Affiliated Hospital of Jinan University, Second Department of Cardiology, Guangdong No. 2 Provincial People's Hospital, Guangzhou, China.
Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China.
出版信息
Ann Noninvasive Electrocardiol. 2016 Jan;21(1):69-81. doi: 10.1111/anec.12276. Epub 2015 May 4.
AIMS
Research related to type 2 diabetes mellitus (DM) and parameters of electrocardiography (ECG) was limited. Patients with and without DM (NDM) were randomly enrolled in a study to exploit the influence of DM on planar QRS and T vectors derived from the Virtual Holter process.
METHODS
A total of 216 (NDM) and 127 DM patients were consecutively and randomly recruited. We selected a 1-minute length of ECG, which was scheduled for analysis at 4 AM. After a series of calculating algorisms, we received the virtual planar vector parameters.
RESULTS
Patients with DM were elderly (65.61 ± 12.08 vs 59.41 ± 16.86 years, P < 0.001); higher morbidity of hypertension (76.38% vs 58.14%, P < 0.001) and coronary artery disease (44.09% vs 32.41%, P = 0.03); thicker interventricular septum (10.92 ± 1.77 vs 10.08 ± 1.96 mm, P < 0.001) and left ventricular posterior wall (9.84 ± 1.38 vs 9.39 ± 1.66 mm, P = 0.03); higher lipid levels and average heart rate (66.67 ± 12.04 vs 61.87 ± 13.36 bpm, P < 0.01); higher angle of horizontal QRS vector (HQRSA, -2.87 ± 48.48 vs -19.00 ± 40.18 degrees, P < 0.01); lower maximal magnitude of horizontal T vector (HTV, 2.33 ± 1.47 vs 2.88 ± 1.89 mm, P = 0.01) and maximal magnitude of right side T vector (2.77 ± 1.55 vs 3.27 ± 1.92 mm, P = 0.03), and no difference in angle of frontal QRS-T vector (FQRSTA, 32.77 ± 54.20 vs 28.39 ± 52.87 degrees, P = 0.74) compared with patients having NDM. After adjusting for confounding factors, DM was significantly effective on FQRSTA (regression coefficient -40.0, 95%CI -66.4 to -13.6, P < 0.01), HQRSA (regression coefficient 22.6, 95%CI 2.5 to 42.8, P = 0.03), and HTV (regression coefficient 0.9, 95%CI 0.2 to 1.7, P = 0.01). Confounding factors included: sex, 2-hour postprandial blood glucose, smoking, triglyceride, apolipoprotein A, creatinine, left ventricular ejection fraction, and average heart rate.
CONCLUSIONS
The risk factors of DM and lipid metabolism abnormality particularly apolipoprotein A significantly modified parameters of virtual planar QRS and T vector, including frontal QRS-T angle.
目的
与2型糖尿病（DM）及心电图（ECG）参数相关的研究有限。将患有和未患有DM（非糖尿病，NDM）的患者随机纳入一项研究，以探讨DM对源自虚拟动态心电图过程的平面QRS波和T波向量的影响。
方法
连续随机招募了216名NDM患者和127名DM患者。我们选取了一段1分钟时长的心电图，安排在凌晨4点进行分析。经过一系列计算算法后，我们得到了虚拟平面向量参数。
结果
DM患者年龄较大（65.61±12.08岁 vs 59.41±16.86岁，P<0.001）；高血压发病率较高（76.38% vs 58.14%，P<0.001）和冠状动脉疾病发病率较高（44.09% vs 32.41%，P = 0.03）；室间隔更厚（10.92±1.77 vs 10.08±1.96 mm，P<0.001）和左心室后壁更厚（9.84±1.38 vs 9.39±1.66 mm，P = 0.03）；血脂水平和平均心率更高（66.67±12.04 vs 61.87±13.36次/分钟，P<0.01）；水平QRS波向量角度（HQRSA）更高（-2.87±48.48 vs -19.00±40.18度，P<0.01）；水平T波向量最大幅值（HTV）更低（2.33±1.47 vs 2.88±1.89 mm，P = 0.01）以及右侧T波向量最大幅值更低（2.77±1.55 vs 3.27±1.92 mm，P = 0.03），与NDM患者相比，额面QRS-T波向量角度（FQRSTA）无差异（32.77±54.20 vs 28.39±52.87度，P = 0.74）。在调整混杂因素后，DM对FQRSTA（回归系数 -40.0，95%置信区间 -66.4至 -13.6，P<0.01）、HQRSA（回归系数 22.6，95%置信区间 2.5至 42.8，P = 0.03）和HTV（回归系数 0.9，95%置信区间 0.2至 1.7，P = 0.01）有显著影响。混杂因素包括：性别、餐后2小时血糖、吸烟、甘油三酯、载脂蛋白A、肌酐、左心室射血分数和平均心率。
结论
DM和脂质代谢异常尤其是载脂蛋白A的危险因素显著改变了虚拟平面QRS波和T波向量的参数，包括额面QRS-T波角度。
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