平板运动试验与心脏变时功能不全对冠状动脉病变的诊断价值  

Clinical study on chronotropic incompetence of treadmill exercise testing and coronary artery disease

作　　者：徐方芳[1] 贾绍斌[1] 沙勇[1] 薛莉[1] 纳丽莎[1] 马瑞琴[1] 

机构地区：[1]宁夏医科大学附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2009年第8期694-696,共3页Ningxia Medical Journal

基　　金：宁夏自然科学基金项目(NZ08113)

摘　　要：目的探讨平板运动试验(treadmill exercise testing,TET)心脏变时功能不全(chronotropic incompe-tence,CI)对冠心病(CHD)患者的的诊断价值及与冠状动脉病变的临床意义。方法165例临床拟诊CHD患者,先后行TET和冠状动脉造影(CAG)检查,对传统指标、CI及两项联合指标诊断CHD的敏感性、特异性、准确率进行比较;并根据CAG结果分CHD组和非CHD组,分析比较两组间心脏变时功能(chronotropic response,CR):运动中心率变化的各项指标和心脏变时指数(chronotropic response index,CRI)。结果(1)单纯以CI指标诊断冠状动脉病变的敏感性、特异性与传统指标相比,无统计学意义(P>0.05),准确率高于传统指标(P<0.05);两项联合指标诊断CHD的敏感性、特异性及准确率均显著高于传统指标(P<0.01)。(2)CHD组运动CR明显低于非CHD组(P<0.01)。CHD组3支冠脉病变者CR明显低于1、2支冠脉病变者(P<0.01)。CRI与冠脉病变分支数目(r=-0.699,P<0.01)呈负性相关。(3)右冠支、回旋支病变的CR均低于前降支病变(P<0.05)。结论CI指标是诊断CHD的重要价值的指标,可以提高TET对CHD的诊断率。CHD患者CI可以预测心肌缺血程度,预测自主神经功能受损情况,提示窦房结发生供血不足的可能性,为临床早期诊治提供更快捷的准确信息。Objective To study the diagnostic value of chronotropic incompetence （CI） in coronary heart disease （CHD）, and clinical relationship of CI of coronary artery disease. Methods 165 patients who underwent the electrocardiogram treadmill exercise test （TET） and coronary angiography （CAG） were included in this study. CAG was used as the standard of diagnosing CHD. The sensitivity, specificity, and accuracy of CI were compared with the traditional index of TET. And then they were put in two groups according to CAG： CHD group and NCHD group, the indices of chronotropie response CR were compared to each other between CHD and NCHD; They were related to CHD （ adopt analysis coefficient of multiple linear correlation）. Results There was no significant difference between the sensitivity, specificity of CI respectively and those of the traditional index respectively （P 〉 0.05 ）, but accuracy were higher. While the sensitivity, the specificity and accuracy were significantly higher after combining CI and the traditional index than that of the traditional index alone （ P 〈 0.01 ）. CR of CHD group were significant lower than that in NCHD group. CR of 3 branchs of the diseased coronary artery were significant lower than CR of 1 branch or 2 branchs of the diseased coronary artery （ P 〈 0.01 ）. There were negative relation beween number of branchs of the diseased coronary artery and CRI （ r = - 0. 699, P 〈 0.01 ）. CR of right coronary artery （RCA） and left circumflex artery （LCX） were lower than one of left anterior descending artery （LAD） （ P 〈 0.05 ）. Conclusion There is important value in diagnosis of CHD by CI index in TET. CI can predict the extent of myocardial ischemia in some degree; maybe re- flect the impairment of cardiac autonomic nervous systemregnlation and sinue hemodynamic. CI can improve value for diagnosis of CHD.

关 键 词：心脏变时功能不全 冠状动脉病变 平板运动试验 

分 类 号：R541.4[医药卫生—心血管疾病]