床旁无创积分法用于初步诊断冠心病的临床研究  

Bedside noninvasive scoring system in diagnosis of coronary heart disease

作　　者：张灿秀[1] 肖喜刚[2] 王岚峰[1] 潘薇[1] 刘洪仁 黄永麟[1] 

机构地区：[1]哈尔滨医科大学附属第一医院心内科,150001 [2]哈尔滨医科大学附属第一医院 CT室,150001 [3]哈尔滨市第一工具厂职工医院

出　　处：《中华全科医师杂志》2012年第1期37-41,共5页Chinese Journal of General Practitioners

基　　金：基金项目：哈尔滨市科技局攻关项目（2007AA3CS082-3）

摘　　要：目的评价床旁无创积分法初步诊断冠心病的有效性。方法2008年9月至2010年10月入选我院612例疑诊冠心病患者（男性343例，女性269例），平均年龄（55±7）岁。对所有患者均详细询问病史和体格检查并检查静息心电图、血生化、平板运动试验和（或）12导联动态心电图，同时进行64排或256排冠状动脉CT成像检查或冠状动脉造影。采用Delphi法，通过对专家多次问卷捌查筛选出评价冠心病可能性的临床指标（性别、年龄、吸烟史、饮酒史、高血压病、高脂血症、糖尿病、典型胸痛及心电图、平板运动试验或动态心电图等）；依据专家做出的危险分层、判断依据水平和熟悉程度量化各指标，其中大量吸烟、糖尿病、典型胸痛、平板运动试验阳性和动态心电图阳性为极高危，积8分；三项血脂异常和合并左心室肥厚的高血压为高危，积6分；≥40岁男性、中等量吸烟、两项血脂异常、血糖异常、大量饮酒、心电图阳性和绝经后女性为中危，积4分；少量饮酒和一项血脂异常为低危，积2分。对所有患者进行床旁无创积分法评价，并与多排螺旋CT或冠状动脉造影结果比较，评价该积分法的价值。结果积分≥24用于初步诊断冠心病标准的敏感性为89．95％，特异性为85．63％，阳性预测值94．03％，但准确性为88．73％。积分≤14用于初步排除冠心病标准的敏感性为93．10％，特异性为82．86％，阴性预测值达98．09％，但准确性为84．80％。准确性均低于多排螺旋CT或冠状动脉造影（均P〈0．05）。结论本床旁无创积分法可作为初筛冠心病的一种方法，且还有待进一步完善。Objectives To evaluate the effectiveness of bedside noninvasive scoring system in diagnosis of coronary heart disease （CAD）. Methods Six hundred and twelve patients with suspected CAD in our hospital were enrolled （343 males and 269 females） from September 2008 to October 2010, with an average age of 55 ± 7 y. The detailed history was taken; physical examination, resting electrocardiogram, blood biochemistry, treadmill exercise test and/or 12 lead Hoher monitoring, 64 or 256 rows CT coronary artery imaging and coronary artery angiography were performed in all patients. The risk factors for CAD were screened by muhiple questionnaire surveys with Delphi method. The risk factors were stratified according to the results of expert storey： heavy smoking, diabetes mellitus, typical angina, positive treadmill exercise test and positive Holter monitoring electrocardiogram were included in the highest risk factors with an integrated scores of 8; dyslipidemia of 3 items, hypertension complicated with left ventricular hypertrophy were high risk factors with an integrated scores of 6; males 40 ≥y, medium smoking, dyslipidemia of 2 items, pathoglycemia, heavy drinking, positive ECG and post-menopause females were moderate risk factors with integrated scores of 4; Low risk factors contain moderate drinking and dyslipidemia of item, were classified as low risk factors with an integrated scores of 2. The bedside noninvasive scoring system was evaluated in all patients and the results were compared with those from muhi-slice spiral CT or coronary angiography. Results When integrated score ≥ 24 was set as the cut-off level for diagnosis of CAD, thesensitivity, specificity, positive predictive value and accuracy were 89.95%, 85.63%, 94.03% and 88. 73% respectively. When integrated score ≤ 14 was set as the exclusion criteria of CAD, the sensitivity, specificity, positive predictive value and accuracy were of 93.10% , 82. 86% , 98.09% and 84. 80% respectively. The accuracy was lower than that of multi-slice spiral CT

关 键 词：冠状动脉疾病 诊断技术 心血管 研究设计 

分 类 号：R541.4[医药卫生—心血管疾病]