Page 28 - 2022-36-中国全科医学

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4.Shanghai Research Center for General Practice and Community Health，Shanghai 200090，China
*
Corresponding author：GE Xuhua，Chief physician，Associate professor，Doctoral supervisor；E-mail：gexuhuaxzyy@aliyun.
com
【Abstract】 Background The new electrocardiogram （ECG） criteria have higher accuracy in the diagnosis of
left ventricular hypertrophy （LVH） in general population with hypertension than traditional ECG voltage criteria. However，
the diagnostic efficacy of new ECG criteria for LVH in overweight and obese patients with hypertension has been rarely reported.
Objective To explore the diagnostic value of new ECG indicators for LVH in overweight and obese patients with hypertension.
Methods A retrospective design was used. A total of 368 overweight and obese patients with hypertension were recruited from
the First Affiliated Hospital of Wannan Medical College from December 2017 to December 2020，and divided into LVH （+）
2
2
group（including males with LVH>115 g/m and females with LVH >95 g/m ） and LVH （-） group（including males with
2
2
LVH ≤ 115 g/m and females with LVH ≤ 95 g/m ）. General data were collected and compared between two groups. Intergroup
comparison was also performed in terms of ultrasonic cardiography（UCG） indicators〔diastolic interventricular septal thickness
（IVST），left ventricular posterior wall thickness （LVPWT），left ventricular mass （LVM），left ventricular mass index
（LVMI），left ventricular ejection fraction（LVEF）〕and ECG indicators〔QRS duration （QRSd），corrected QT interval
（QTc），Sokolow-Lyon voltage criteria，Cornell voltage criteria，Peguero Lo-Presti voltage criteria，Cornell product〕with
the accuracy of UCG indicators as the gold standard. Binary Logistic regression model was used to analyze the influencing factors of
LVH in hypertension with overweight or obesity. ROC analysis was used to evaluate the diagnostic efficacy of new ECG indicators
（Sokolow-Lyon voltage criteria，Cornell voltage criteria，Peguero Lo-Presti voltage criteria，Cornell product） for LVH in
hypertension with overweight or obesity. Results There were statistically significant differences in sex ratio，mean age，body
surface area （BSA），SBP，DBP，β-blocker utilization rate and blood pressure control between LVH （+） and LVH （-）
groups（P<0.05）. The mean values of IVST，LVPWT，LVM，LVMI，QRSd，QTc，Sokolow-Lyon voltage criteria，Cornell
voltage criteria，Peguero Lo-Presti voltage criteria and Cornell product in LVH （+） group were higher than those in LVH （-）
group（P<0.05）. The mean LVEF value in LVH （+） group was lower than that in LVH （-） group （P<0.05）. Age 〔OR=1.046，
95%CI （1.024，1.069）〕 and Sokolow-Lyon voltage criteria〔OR=1.793，95%CI （1.305，2.463）〕 were influential
factors for LVH risk in hypertension with overweight or obesity （P<0.05）. The AUC of Sokolow-Lyon voltage criteria，Cornell
voltage criteria Peguero Lo-Presti voltage criteria and Cornell product for LVH diagnosis in hypertension with overweight or obesity
was 0.674，0.695，0.662 and 0.722，respectively. The AUC of the combined diagnostic model with age，BSA，SBP，DBP，
time of the duration of hypertension，QRSd，QTc，Sokolow-Lyon voltage criteria，Cornell voltage criteria，Peguero Lo-Presti
voltage criteria，and Cornell product incorporated was 0.846. Conclusion In overweight and obese people with hypertension，
the Sokolow-Lyon voltage criteria was associated with LVH. Moreover，the new ECG indicator Peguero Lo-Presti voltage criteria
was less effective than Cornell product and other traditional ECG indicators in diagnosing LVH. The combined diagnostic model
has proven to be with better diagnostic performance for LVH，which is recommended to be used and promoted in primary care
settings with relatively unsatisfactory examination conditions.
【Key words】 Overweight；Obesity；Hypertension；Hypertrophy，left ventricular；Electrocardiography；Diagnosis

目 前 已 有 三 十 多 项 心 电 图（electrocardiogram， 皖南医学院第一附属医院收治的 368 例高血压病患者为
ECG）标准用于普通人群左心室肥厚（left ventricular 研究对象。经本院医学伦理委员会批准伦理〔审核批
hypertrophy，LVH）的诊断，常用诊断标准有 Sokolow- 号：2022 伦审研第（30）号〕。回顾性分析其临床资
Lyon 电压、Cornell 电压、Cornell 乘积标准等 ［1］ 。近年 料，其中男 239 例，女 129 例，年龄 19~85 岁，平均年
来，Peguero Lo-Presti 电压标准被应用于普通高血压人 龄（54.4±15.7）岁。
群 LVH 的诊断 ［2］ 。有研究表明，相较于传统电压标准， 纳入标准：（1）符合《中国成人肥胖症防治专家
此电压标准诊断 LVH 时有更高的准确性 ［3-5］ ，但其对 共识》中超重与肥胖的诊断标准 ［6］ ，体质指数（body
2
超重和肥胖人群 LVH 的诊断效能鲜有报道。本研究以 mass index，BMI）≥ 24 kg/m ；（2）符合《中国高血
超重和肥胖人群为研究对象，对 ECG 新标准在高血压 压防治指南（2018 修订版）》高血压病诊断标准 ［7］ ；
合并超重和肥胖人群中的诊断效能进行评价，以期为上 （3） 在 院 期 间 均 行 ECG 及 超 声 心 动 图（ultrasonic
述人群提供更全面的检查手段。 cardiography，UCG）检查；（4）临床相关资料完整、真实、
1 资料与方法 可靠。
1.1 一般资料 选择 2017 年 12 月至 2020 年 12 月在 排除标准：胸腔积液，心包积液，妊娠，血液透析