腺苷超声心动图与腺苷负荷心肌灌注显像诊断冠心病的价值  

The value of adenosine echocardiography and adenosine SPECT in diagnosis of coronary heart disease

作　　者：李晓燕[1] 陈国栋[1] 梁春香[1] 谈红[1] 张红明[1] 赵修义[1] 

机构地区：[1]济南军区总医院,济南250031

出　　处：《中华老年心脑血管病杂志》2009年第5期330-332,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨腺苷超声心动图负荷试验(ASF)与腺苷负荷^(99m)Tc心肌灌注显像(Ad-SPECT)诊断冠心病的价值。方法选择临床拟诊断为稳定性心绞痛的住院患者86例,同期行ASE和Ad-SPECT单项及联合试验,观察腺苷静脉滴注后心率、血压及其不良反应发生情况。结果 86倒患者接受冠状动脉造影检查,阳性62例,阴性24例。ASF诊断冠心病的敏感性、特异性和准确度分别为74%、79%和76%,Ad-SPECT分别为87%、62%和80%,ASE及Ad-SPECT的联合平行试验敏感性、特异性和准确度分别为97%、63%和87%,联合系列试验分别为65%、88%和80%。联合平行试验的敏感性与各单项试验敏感性之间、联合系列试验的特异性与各单项试验特异性之间差异有统计学意义(P<0.05)。结论腺苷负荷试验安全、可靠,ASE及Ad-SPECT诊断冠心病特异性、敏感性均较高,联合试验可进一步提高诊断冠心病的价值。Objective To investigate the value of adenosine echocardiography（ASE）and adenosine single photon emission computed tomography （Ad-SPECT）for diagnosis of coronary heart disease. Methods Ad-SPECT and ASE were performed in 86 patients with suspected stable angina pectoris. All of the patients received coronary angiography. The results in them were compared. The side effects of adenosine stress were observed. Results Sixty-two patients had significant coronary artery stenosis and 24 had normal angiography. ASE showed a sensitivity of 74 %, specificity of 79 %, positive predictive value of 90 %, negative predictive value of 54 % and diagnostic accuracy of 76% for diagnosis of coronary heart disease（CHD）. Ad-SPECT showed sensitivity of 87% ,specificity of 62%,positive predictive value of 86% ,negative predictive value of 65% and diagnostic accuracy of 80%. The sensitivity of combined ASE and Ad-SPECT parallel test for detection of CHD was 97% and the specificity of serial test was 88% （P〈0.05 vs ASE and Ad-SPECT）. The side effects of adenosine stress included chest pain, dyspnea and headache, etc. Conclusion ASE and Ad-SPECT were safe and accurate methods for diagnosis of CHD. Combined test can elevate the diagnostic value for CHD.

关 键 词：腺苷 超声心动描记术 压力 心肌再灌注 诊断显像 冠状动脉疾病 

分 类 号：R541.4[医药卫生—心血管疾病]