目的：探讨微伏T波交替对缺血性心脏病患者伴发室性心律失常危险的预测价值。方法纳入2012年1月至2013年11月在肇庆医专附属医院心内科确诊为缺血性心脏病患者100例，均通过微伏T波交替检测，根据结果分为微伏T波交替阳性组53例及微伏T波交替阴性组47例，同时选取在本院体检中心就诊经心电图、X胸片、心脏彩超检测均正常的对照组50例。分别对三组研究对象于住院期间行心电监护监测，患者出院后继续随访1年，复查动态心电图观察室性心律失常的发病情况。结果微伏T波交替阳性组和阴性组缺血性心脏病患者的心率、心功能、射血分数等指标与对照组相比具有统计学差异（P＜0.05）；对照组未发生室性心律失常，微伏T波交替阳性组患者室性心律失常的发生率为84.91%，高于微伏T波交替阴性组（48.94%），且两组间具有统计学差异（P＜0.05）。微伏T波交替预测室性心律失常的灵敏度66.17%，特异性75.0%，阳性预测值84.91%，阴性预测值51.06%。结论缺血性心脏病患者微伏T波交替阳性与室性心律失常发生密切相关，对室性心律失常具有一定的预测价值。%Objective To discuss the predictive value of microvolt T wave alternans (TWA) to risk of ventricular arrhythmia in patients with ischemia heart disease. Methods The patient (n=100) were chosen from Jan. 2012 to Nov. 2013, and given TWA examination. All patients were divided, according to the outcomes of TWA, into positive TWA group (n=53) and negative TWA group (n=47), and other 50 cases with normal outcomes of ECG, chest X-ray and myocardial contrast echocardiography were chosen as control group. All groups were given ECG monitoring during hospitalization. After patients were discharged from hospital, they were followed up for 1 y and then given re-examination with Holter for observing the incidence of ventricular arrhythmias. Results The comparison in heart rate, heart function and LVEF had no statistical difference between positive TWA group or negative TWA group and control group (P<0.05). There was no case with ventricular arrhythmias in control group, and incidence of ventricular arrhythmias was 84.91%in positive TWA group and 48.94%in negative TWA group (P<0.05). The sensitivity of TWA for predicting ventricular arrhythmias was 66.17%, specificity was 75.0%, positive predicted value was 84.91%, and negative predicted value was 51.06%. Conclusion Positive TWA is closely correlated to incidence of ventricular arrhythmias in patients with ischemia heart disease, which has certain predictive value.
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