64层螺旋CT冠状动脉成像对冠心病诊断的应用价值  

Diagnostic value of 64-slice spiral computed tomography coronary angiography for coronary artery disease

作　　者：刘品明[1] 郑海生[3] 罗年桑[1] 李国照[2] 王景峰[1] 

机构地区：[1]中山大学孙逸仙纪念医院心内科,广州510120 [2]中山大学孙逸仙纪念医院放射科,广州510120 [3]汕头市中心医院中山大学附属汕头医院心内科

出　　处：《中华心血管病杂志》2010年第10期909-913,共5页Chinese Journal of Cardiology

基　　金：基金项目：广东省科技计划项目（2005830601018,20078031508005）

摘　　要：目的 通过探讨64层螺旋CT冠状动脉成像（64-SCTCA）对冠心病诊断的应用价值以明确临床上适于该项检查的人群.方法 回顾性分析285例接受64-SCTCA检查、并于4周内接受冠状动脉造影（CAG）检查的冠心病疑诊患者的临床资料.依照冠心病概率Duke模型,将受检者分为冠心病低危（n=80）、中危（n=92）和高危（n=113）3组,以CAG为＂金标准＂,判断64-SCTCA诊断冠心病的准确性以及冠状动脉钙化、不同部位血管节段等因素对诊断准确性的影响.结果 64-SCTCA诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值和诊断准确指／数分别为81.2%、93.3%、68.0%、96.6%和74.5%.冠心病概率Duke模型的低危组、中危组和高危组,其冠心病检出率分别为46.3%、72.8%和82.3% 64-SCTCA在低危组诊断冠心病的敏感性及阳性预测值明显低于中危组和高危组.对于冠状动脉Agatston钙化积分＞400分组,64-SCTCA诊断冠心病的敏感性（95.0%）明显高于0～100分组和101～400分组（77.4%和77.3%,P均＜0.05）,特异性（82.2%）明显低于上述两组（94.0%和95.3%,P均＜0.05）.其诊断远端血管病变的敏感性、阳性预测值均明显低于近、中段血管（P均＜0.05）.结论 64-SCTCA主要适用于冠心病概率Duke模型临床分层的中危人群.其诊断准确性受冠状动脉钙化、病变部位、管腔直径等因素影响.Objective To assess the diagnostic accuracy of 64-slice computed tomography coronary angiography （64-SCTCA） in individuals with suspected coronary artery disease （CAD）. Methods The study enrolled 285 individuals undergoing 64-SCTCA with calcium scoring and thereafter invasive coronary angiography （CAG） within 4 weeks for suspected CAD. Pretest probability of having obstructive CAD was determined using the Duke clinical score, which was estimated by type of chest discomfort, age, gender,and traditional risk factors and stratified into 3 levels of probability： low （ ≤ 30%, n = 80）, intermediate （31% to 70%, n =92）, and high （ ≥71%, n = 113）. CAD was defined as the presence of at least one vessel of ≥50% coronary stenosis on CAG. Results The patient-based diagnostic accuracy of 64-SCTCA for detecting CAD according to CAG revealed a sensitivity of 81.2%, a specificity of 93.3%, a positive predictive value of 68.0% and negative predictive value of 96.6%. The CAD prevalence in the low,intermediate and high risk groups according to Duke probability was 46.3%, 72.8% and 82.3%,respectively. The sensitivity and positive predictive value were lower in the low probability group than those in the intermediate and high probability groups. For those with coronary artery Agatston calcium score 〉400, the diagnostic accuracy was linked with a higher sensitivity but lower specificity. The diagnostic value of 64-SCTCA for proximal and mid-segment of coronary artery was superior to that for distal segment. Conclusions 64-SCTCA is mainly indicated in individuals with an intermediate probability of having CAD. The diagnostic value of 64-SCTCA could be affected by coronary artery calcium, lesion location and vessel diameter.

关 键 词：冠状动脉疾病 体层摄影术 X线计算机 心血管造影术 诊断 

分 类 号：R686[医药卫生—骨科学]