【摘要】 目的 探讨平板运动试验中冠心病患者与冠状动脉正常者QT离散度(QTd)变化的意义。方法 分析经冠状脉动(冠脉)造影证实的13例冠心病患者与17例冠脉造影正常者平板运动试验前、试验中ST段下移0.1mV以上或出现典型心绞痛症状或达亚极量心率时以及运动后体表12导联心电图QTd变化。结果 运动前、中、后冠心病组QTd分别为46.2±20.1ms，71.9±20.4 ms及51.2±14.5 ms；而冠状动脉正常组分别为32.3±6.6 ms，30.9±9.2ms与29.4±8.5 ms，两组相比P均<0.01；冠心病组QTd运动中与运动前后相比P均<0.01，而冠脉正常组差异无显著性；以运动中QTd≥60ms判为异常，诊断冠心病的敏感性为92.3%，特异性100%，准确性96.7%。结论 冠心病患者运动试验中QTd进一步显著增加，QTd是运动试验中诊断冠心病心肌缺血敏感而特异的指标。

    The significance of QT dispersion during exercise treadmilltest in patients with coronary heart disease ZhangQunlin, Ge Yonggui, Wang Wei, et al. Department of Cardiology, Taihe Hospital, Shiyan,Hubei 442000

     【Abstract 】 Objective To investigate theclinical significance of QT dispersion during exercise treadmill test in patients with andwithout coronary artery disease.Methods QTdispersion of 12-lead surface ECG was measured before, during when ST segments depressionwas more than 1 mm or typical angina occurred or submaximal heart rate was achieved, andafter exercise treadmill test in 13 patients with coronary artery disease and 17 patientswith normal coronary arteries identified by coronary angiography.Results The QT dispersions were significantly increased in patients withcoronary artery disease before, during and after exercise (46.2±20.1 ms, 71.9±20.4 msand 51.2±14.5 ms, respectively) compared with those in patients with normal coronaryarteries (32.3±6.6, 30.9±9.2 and 29.4±8.5 ms, respectively), all P<0.01. In patientswith coronary artery disease, QT dispersions were significantly increased during exercisecompared with those before and after exercise (P <0.005).There were no significant changes in QT dispersion in patients with normal coronaryarteries before, during and after exercise. Stress QT dispersion of ≥60 ms had a sensitivity of 92.3%, specificity of 100%, accuracy of96.7% for the diagnosis of coronary artery disease.Conclusion QT dispersion is significantly increased in patients with coronaryartery disease during exercise test. QT dispersion during exercise treadmill test could beused as a sensitive and specific index for the diagnosis of coronary heart disease.

     【Key words 】 exercise treadmill test QTdispersion coronary artery disease

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