ST-T改变联合颈动脉斑块发生对外科患者发生冠心病诊断价值  

The role of ST-T changes and carotid plaque in the diagnosis of coronary heart disease in surgical patients

作　　者：罗慧敏 徐振东 何涛 吴晓燕[1] 范永臻 王海蓉[1] 鲁志兵 陈明[1] LUO Hui-min;XU Zhen-dong;HE Tao;WU Xiao-yan;FAN Yong-zhen;WANG Hai-rong;LU Zhi-bing;CHEN Ming(Department of Cardiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院心内科,湖北武汉430071

出　　处：《临床军医杂志》2022年第11期1139-1143,共5页Clinical Journal of Medical Officers

基　　金：湖北省自然科学基金项目资助(2020CFB738)

摘　　要：目的探讨心电图ST-T段改变及颈动脉斑块发生在外科患者冠心病中的诊断价值。方法选取自2017年12月至2020年12月于武汉大学中南医院住院的疑似冠心病且在住院期间均接受了静息心电图、颈动脉超声和冠状动脉造影检查等相关检查的111例疑似冠心病外科患者为研究对象。根据冠状动脉造影结果,将疑似冠心病的外科患者分为冠心病组(n=28)与非冠心病组83例(n=83)。回顾性分析患者的冠状动脉造影、心电图、颈动脉超声和基本临床资料,并利用灵敏度、特异度、阳性似然比和阴性似然比评估危险因素对冠心病的诊断价值。结果冠心病组患者的年龄、血清肌钙蛋白I、血清氨基末端脑钠肽前体水平,以及ST-T改变和颈动脉斑块发生率均高于非冠心病组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,男性、ST-T改变及颈动脉斑块是外科患者冠心病的独立危险因素(P<0.05)。以冠状动脉造影结果为诊断冠心病的“金标准”,ST-T改变诊断外科患者冠心病的灵敏度为67.9%,特异度为56.6%,阳性似然比为1.56,阴性似然比为0.57;颈动脉斑块诊断外科患者冠心病的灵敏度为89.3%,特异度为65.1%,阳性似然比为2.56,阴性似然比为0.16;联合ST-T改变及颈动脉斑块结果诊断外科患者冠心病的灵敏度为96.4%,特异度为35.0%,阳性似然比为1.48,阴性似然比为0.10。结论ST-T改变和颈动脉斑块可作为外科患者冠心病的诊断指标,并且二者结合能更有效地预测冠心病。Objective To explore the guiding value of electrocardiogram ST-T changes and carotid plaque in the clinical diagnosis of coronary heart disease(CHD).Methods A total of 111 surgical patients with suspected coronary heart disease who were hospitalized in Zhongnan Hospital of Wuhan University from December 2017 to December 2020 and received resting electrocardiogram,carotid ultrasound,coronary angiography and other related examinations during hospitalization were selected as subjects.According to the results of coronary angiography,surgical patients with suspected coronary heart disease were divided into CHD group(n=28)and non-CHD group(n=83).Coronary angiography,electrocardiogram,carotid ultrasound and basic clinical data of patients were retrospectively analyzed,and sensitivity,specificity,positive likelihood ratio and negative likelihood ratio were used to evaluate the diagnostic value of risk factors for coronary heart disease.Results The age,serum troponin I,serum amino terminal brain natriuretic peptide precursor levels,ST-T changes and carotid artery plaque incidence in CHD group were higher than those in non-CHD group,with statistical significance(P<0.05).Multivariate Logistic regression analysis showed that male,ST-T changes and carotid plaque were independent risk factors for coronary heart disease in surgical patients(P<0.05).Using the results of coronary angiography as the“gold standard”for the diagnosis of coronary heart disease,the sensitivity and specificity of ST-T changes in the diagnosis of coronary heart disease in surgical patients were 67.9%and 56.6%,positive likelihood ratio was 1.56,negative likelihood ratio was 0.57.The sensitivity and specificity of carotid artery plaque in the diagnosis of coronary heart disease in surgical patients were 89.3%and 65.1%,positive likelihood ratio was 2.56 and negative likelihood ratio was 0.16.The sensitivity and specificity of the combination of ST-T changes and carotid plaque findings in the diagnosis of coronary heart disease in surgical patients were

关 键 词：冠心病 ST-T改变 颈动脉斑块 冠状动脉造影 

分 类 号：R541.4[医药卫生—心血管疾病]