2021 年第 2 期 第 16 卷

间歇性完全性左束支传导阻滞结合心率变异性对高血压左心室肥厚的诊断价值

Diagnostic value of intermittent complete left bundle branch block combined with heart rate variability in hypertensive left ventricular hypertrophy

作者：张文婷1任淑珍1白雪琴1张爱婷1程佳媛1房志琴2史建林3

英文作者：Zhang Wenting1 Ren Shuzhen1 Bai Xueqin1 Zhang Aiting1 Cheng Jiayuan1 Fang Zhiqin2 Shi Jianlin3

单位：1河北北方学院附属第一医院心脏功能检查科，河北省张家口市075000；2河北北方学院附属第一医院心血管内科，河北省张家口市075000；3河北省张家口市妇幼保健院计划生育科075000

英文单位：1Department of Electrocardiogram the First Affiliated Hospital of Hebei North University Hebei Province Zhangjiakou 075000 China; 2Department of Cardiology the First Affiliated Hospital of Hebei North University Hebei Province Zhangjiakou 075000 China; 3Deparment of Family Planning Zhangjiakou Maternal and Child Health Care Hospital Heibei Province Zhangjiakou 075000 China

关键词：左心室肥厚；间歇性完全性左束支传导阻滞；心率变异性；时域指标；频域指标

英文关键词：Leftventricularhypertrophy;Intermittentcompleteleftbundlebranchblock;Heartratevariability;Timedomainindicator;Frequencydomainindicator

• 摘要：

• 目的 探讨间歇性完全性左束支传导阻滞(LBBB)结合心率变异性(HRV)对高血压左心室肥厚的诊断价值。方法 选取2018年7月至2020年7月于河北北方学院附属第一医院就诊的左心室肥厚患者100例，分为高血压左心室肥厚组（40例）、冠心病（冠状动脉粥样硬化性心脏病）所致左心室肥厚组（32例）、主动脉瓣狭窄所致左心室肥厚组（15例）及肥厚型心肌病所致左心室肥厚组（13例）。记录患者的24 h动态心电图，比较4组患者间歇性完全性LBBB发生率及HRV差异。结果 高血压左心室肥厚组与冠心病所致左心室肥厚组间歇性完全性LBBB发生率差异无统计学意义［30.0%(12/40)比28.1%(9/32)］（P＞0.05），此2组间歇性完全性LBBB发生率均明显高于主动脉瓣狭窄所致左心室肥厚组及肥厚型心肌病所致左心室肥厚组［6.7%(1/15)、7.7%(1/13)］（均P＜0.01）。高血压左心室肥厚组HRV时域指标全部窦性心搏间期的标准差(SDNN)明显高于冠心病所致左心室肥厚组和主动脉瓣狭窄所致左心室肥厚组［（164±58）ms比（126±45）、（115±22）ms］（均P＜0.01），与肥厚型心肌病所致左心室肥厚组［（138±71）ms］差异无统计学意义（P＞0.05），其余3组间SDNN比较差异无统计学意义（P＞0.05）。4组患者间HRV频域指标极低频功率比较差异无统计学意义（P＞0.05）。结论 间歇性完全性LBBB与HRV时域指标SDNN对高血压左心室肥厚与其他器质性心脏病所致左心室肥厚的鉴别诊断有一定价值。

• Objective To investigate the diagnostic value of intermittent complete left bundle branch block (LBBB) combined with heart rate variability (HRV) in hypertensive left ventricular hypertrophy. Methods From July 2018 to July 2020, 100 patients with left ventricular hypertrophy in the First Affiliated Hospital of Hebei North University were selected and divided into hypertensive left ventricular hypertrophy group(40 cases), left ventricular hypertrophy caused by coronary atherosclerotic heart disease (coronary heart disease) group(32 cases), left ventricular hypertrophy caused by aortic stenosis group(15 cases) and left ventricular hypertrophy caused by hypertrophic cardiomyopathy group(13 cases). The 24 h ambulatory electrocardiogram  was recorded to compare the incidence of intermittent complete LBBB and difference of HRV among the four groups. Results  There was no significant difference in the incidence of intermittent complete LBBB between hypertensive left ventricular hypertrophy group and left ventricular hypertrophy caused by coronary heart disease group［30.0%(12/40) vs 28.1%(9/32)］(P＞0.05). The incidences of intermittent complete LBBB in hypertensive left ventricular hypertrophy group and left ventricular hypertrophy caused by coronary heart disease group were higher than those in the left ventricular hypertrophy caused by aortic stenosis group and left ventricular hypertrophy caused by hypertrophic cardiomyopathy group［6.7%(1/15), 7.7%(1/13)］(all P＜0.01). Standard deviation of NN intervals (SDNN) of HRV time domain index in hypertensive left ventricular hypertrophy group was significantly higher than that in left ventricular hypertrophy caused by coronary heart disease group and left ventricular hypertrophy caused by aortic stenosis group［（164±58）ms vs （126±45）,（115±22）ms］(both P＜0.01), and there was no significant difference in SDNN compared with left ventricular hypertrophy caused by hypertrophic cardiomyopathy group ［（138±71）ms］(P＞0.05). There were  no significant differences in SDNN among the other three groups(P＞0.05). There were no significant differences in extremely frequency domain indicator of HRV among the four groups(P＞0.05). Conclusion Intermittent complete LBBB and HRV time domain index SDNN have certain value in the differential diagnosis of hypertensive left ventricular hypertrophy and other organic heart diseases.