无胸痛症状疑诊冠心病患者的诊断评分方案研究  

Establishment of diagnostic scoring scheme for no chest pain coronary heart disease

作　　者：吴贵军[1] 韩雅玲[1] 荆全民[1] 王效增[1] 李毅[1] 邓捷[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,北京100034

出　　处：《中国实用内科杂志》2012年第4期286-289,共4页Chinese Journal of Practical Internal Medicine

基　　金：十一五国家科技支撑计划(2006BAI01A02)

摘　　要：目的在无胸痛症状就诊的疑诊冠心病(CHD)患者中建立高效预测CHD可能性的诊断评分系统。方法回顾性分析1447例入院疑诊CHD的无胸痛症状但存在心悸、气短等其他不适症状的患者,对相关临床因素进行Logistic多因素回归分析,筛选危险因素并对危险因素依据比值比(OR)值分别赋值,同时计算危险积分。建立以非胸痛症状就诊人群CHD诊断评分方案。通过计算受试者工作特性(ROC)曲线下面积及进行危险积分和CHD发生率相关性分析,检验诊断评分方案的效能。结果无胸痛症状的疑诊CHD人群的CHD发生率为53.70%。年龄、男性、吸烟史、高血压及糖尿病史是非胸痛症状就诊人群的CHD危险因素。诊断评分方案:ROC曲线下面积为0.730,并具有统计学意义。通过ROC曲线确定诊断临界点为6分,评分方案敏感度0.743、特异度0.624。危险积分范围:0～13分。危险积分越高,CHD发生率越高。危险积分和CHD发生率呈线性关系。结论诊断评分方案简单、实用,可有效预测无胸痛就诊的人群CHD的可能性,在临床实践中有重要意义。Objective To establish a diagnostic scoring system for highly effective prediction of coronary heart disease （CHD） without chest pain. Methods A retrospective study was done in 1447 SAP in-patients diagnosed with suspected CHD of no chest pain but other uncomfortable symptoms such as palpitation and short breath. The relative clinical factors were analyzed with Logistic multi-factor retrospective analysis, and the risk factors were selected and assigned according to OR value. Meanwhile, the risk scores were calculated. Thereafter, the diagnostic scoring scheme was established for highly effective prediction of CHD without chest tlain. Furthermore, the diagnostic scoring scheme was examined by calculating the area under receiver operating characteristics （ROC） （AUROC） and analyzing the correlation between risk score and preva- lence rate of CHD. Results The prevalence rate of CHD was 53.70% in patients with suspected CHD but without chest pain. Age, male, smoking history,hypertension and diabetes were the risk factors of no chest pain CHD. For the diagnostic scoring scheme, the AUROC was O. 730,with statistical significance. The critical point of diagnosis could be determined as 6 scores by AUROC, the sensitivity of scoring scheme 0. 743, and the specificity 0. 624. The risk score scope was 0 -13 scores, with higher occurrence of CHD along with higher risk scores. The risk score was linearly related with occurrence of CHD. Conclusion The diagnostic scoring scheme was simple and practical in efficiently predicting the probability of no chest pain CHD in SAP patients ,which might he of great significance in clinical practice.

关 键 词：诊断评分方案 危险积分 ROC曲线下面积 危险分层 

分 类 号：R541.4[医药卫生—心血管疾病]