4种无创性检查及其组合对冠心病诊断的辅助作用研究  

Noninvasive examinations plus clinical risk factors for auxiliary diagnosis of coronary heart disease

作　　者：刘亚斌[1] 韩雅玲[1] 荆全民[1] 王效增[1] 李毅[1] 张磊[1] 霍勇[2] 张岩[2] 

机构地区：[1]沈阳军区总医院心内科,沈阳110016 [2]北京大学第一医院心内科,北京100034

出　　处：《中国实用内科杂志》2011年第12期930-933,共4页Chinese Journal of Practical Internal Medicine

基　　金："十一五"国家科技支撑计划项目(2006BAI01A02)

摘　　要：目的评价几种无创性检查联合临床危险因素对冠心病诊断的辅助价值。方法选择2001年1月至2007年3月在全国20家三级甲等医院心内科住院疑诊冠心病并初次行诊断性冠状动脉造影(CAG)的患者。纳入常见的临床危险因素后,评价4种无创性检查(包括动态心电图、负荷心电图、负荷核素心肌显像、冠脉CT)及其组合对冠心病诊断的敏感度、特异度。结果无创性检查组合在冠心病诊断中的敏感度为56.02%～87.43%,特异度为36.13%～89.66%,阳性预测值为58.83%～97.73%,阴性预测值为30.21%～73.36%。将危险因素纳入后共同参与判别,未提高判别能力。结论无创性检查组合可作为诊断冠心病的重要方法,动态心电图和冠脉CT组合可作为各级别医院冠心病筛查的基本及重要手段,临床危险因素未增加冠心病诊断的判别能力。Objective To evaluate values of non-invasive examinations plus clinical risk factors in auxiliary diagnosis of coronary heart disease. Methods The investigation was conducted in patients who had first undergone CAG from January 2001 through March 2007 in 20 top Chinese hospitals. In the auxiliary diagnosis of coronary heart disease, non-invasive examinations, including Hoher, treadmill exercise test （ TET ） , radionuelide myocardial perfusion imaging （MPI） ,multislice spiral computed tomography （MSCT） and their combinations,were used with additional consideration of common clinical risk factors. The sensitivities and speeificities of different diagnostic strategies were determined in the auxiliary diagnosis of coronary heart disease. Results The sensitivities of different combinations of uon-invasive examinations ranged from 56. 02% to 87.43% , the specifieities ranged from 36. 13% to 89. 66% ,the positive predictive rates ranged from 58.83% to 97.73%, and the negative predictive rates ranged from 30. 21% to 73.36%. The addition of clinical risk factors into the auxiliary diagnosis was not found to improve the discrimination capability. Conclusion Combination of non-invasive examinations can be used as a basic and significant diagnostic method for coronary artery disease, particularly the combination of Holter and MSCT, in various levels of hospitals. Clinical risk factors may not contribute to the improved discrimination capability in auxiliary diagnosis of coronary heart disease.

关 键 词：冠心病 24 h动态心电图 负荷心电图 多层螺旋CT 核素心肌灌注显像 冠状动脉造影 

分 类 号：R541.5[医药卫生—心血管疾病]