肺結核患者の心電圖に關する統計的研究(第2報) : 肢誘導點電位心電圖と性及び年齡との關係

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Introduction Reports are scanty about this problem except some reporting that right ventricular preponderance is popular among young individuals with pulmonary tuberculosis, and left ventricular preponderance among aged individuals with pulmonary tuberculosis. This section of report is intended to examine the relationship between findings of the φ-pattern and sex or age.Method and Result Age distribution of the patients examined, 453 males and 247 females, was as follows : in descending order of the size of population, 328 cases of age 20-29; 162 cases of 30-39; 89 cases of 19 or below; 73 cases of 40-49 ; 48 cases of 51 or above. With such age distribution in mind, elecrocardiographical findings as described in Report 1 were analysed.Excluding 6 cases of low voltage out of 700 cases, materials here discussed include 451 males and 243 females. In males, frequency of incidence was, in descending order, normal type, vertical type, right axis deviation, level type, left axis deviation. In female, however, level type fell on the 3rd, right axis deviation on the 4th seat. Female-male comparison in term of respective position type disclosed the following : normal type, vertical type, especially the latter were of low incidence in females, while level type, left axis deviation were of twice as high frequency in female as in male. Along with age, normal type became less and less frequent, while vertical type became more popular, reaching a point where normal type-vertical type relation is inverted. Along with age, level type, left axis deviation decreased their incidence, while right axis deviation became popular. This was so in male, but not in female.Male had normal T wave with high frequency, but, on the contrary, female showed abnormal T wave in an overwhelming majority. Such abnormal T wave in female was severe in grade and it included many cases of low voltage. In young individuals incidence of abnormal T wave was rather popular; however, as age increases, normal T wave usurped abnormal wave more and more. Low voltage had a tendency to occur more popularly at higher ages. This relation held for male, but not readily for female. Degree of T wave abnormalities became severer along with age and this applies to male distinctly than to female.Discussion In view of the fact that right axis deviation is popular in healthy young individuals and left axis deviation in aged individuals, it appears problematical to adhere to the hitherto accepted view that young patients with pulmonary tuberculosis show right ventricular preponderance with high frequency. The basis of hitherto accepted view, that is, the right ventricular preponderance results from right ventricular overloading, owing to an increased resistance to the pulmonary circulation, is itself free to conjecture. In this paper the author will abstain from discussing the validity of such view, partly because there is a glaring evidence, according to this study of the author's, that right axis deviation occurs with nearly the same frequency in healthy population and patients population. Vertical type is popular among young individuals. It increases quite remarkably with age. Normal type, level type, left axis deviation decreases along with age. This distribution is different from that holding for healthy population. It also differes from hitherto reported distribution of position type among the patients with pulmonary tuberculosis. That level type left axis deviation are frequent in association with normal T wave in female patients appears to reflect the effect of similar distribution that occurs in healthy female population. In association with abnormal T wave there occurs increase in incidence of vertical type, right axis deviation, special feature of pulmonary tuberculosis, suggesting possible close relation between abnormal T wave and abnormalities in position type.Along with age normal T wave becomes popular and abnormal T wave less popular, and low voltage increases. Along with age there is an increase in injury II, IV. That is, at high age there are more and more patients with frank manifestation of intrinsic myocardial damage, such as flattening of T wave, so frank as can be well evaluated with hitherto employed method of estimation. Popular are injury III, IV among young individuals. They are not popular among aged individuals. This will be explained by postulating that elapse of time has such effect as restoring a majority of altered T wave back to normal T wave and pushing the minority into more damaged abnormal T wave, so that at higher ages abnormal T becomes less popular and normal T more popular. This suggests that slight T abnormalities associated with pulmonary tuberculosis is reversible, and this may be well explained in term of the effect of tubercle bacillus toxin or allergic myocarditis as contended by Maekawa et al.That T abnormalities decrease and vertical type increases at higher age may sound contradictory. However, as was discussed before, change in position type precedes that of T wave, and, no matter to what extent T wave abnormalities are minimized by the effect of vertical type, the change in position type will not be altered in one way or another. This also constitutes a counter-evidence against the hitherto accepted opinion that right ventricular preponderance is the predominant feature of the pulmonary tuberculosis. Increase in incidence of vertical type at higher ages, according to the author's opinion, is to be ascribed to the long course of the disease and recurring exsudative, active mechanisms in the meantime, and consequent myocardial atonia.Summary(1) On 700 cases of pulmonary tuberculosis not surgically treated, the author carried out a study of position type and T wave abnormalities, their relation to sex and age, employing φ-pattern^*.(2) For male, frequency of incidence is, in descending order, normal type, vertical type, right axis deviation, level type, left axis deviation. For female, the order of level type and vertical type is inverted, but, in association with abnormal T wave, vertical type becomes popular.(3) Vertical type becomes popular along with age.(4) In male normal T wave predominates in number, abnormal T wave slighter in degree. In female abnormal T wave predominates in number. It is severe in degree, too.(5) Along with age normal T wave becomes popular and low voltage shows a tendency to increase. Along with age there is a tendency for frankly flat T wave to increase in incidence and abnormalities in φ_L-pattern (left hand lead point E. C. G) to decrease.(6) From paragraph(3)and (5), it is suggested that T wave abnormalities are reversible, that change of position type precedes that of T wave, and persists even after T wave abnormalities subsided.(7) The change in position type is not that of right axis deviation due to an overloading of the right ventricle, but that of vertical type due to myocardial atonia resulting from prolonged course and recurring exsudative active mechanisms. Reversibility of slight T abnormalities may be due to the same reason.
社団法人日本循環器学会の論文
1956-05-20

著者

松岡薫
京都大學醫學部内科學第三講座:國立療養所貝塚千石荘

肺結核患者の心電圖に關する統計的研究(第2報) : 肢誘導點電位心電圖と性及び年齡との關係

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