心肌缺血总负荷对可疑冠心病患者的诊断价值  

Value of total ischemia burden for diagnosis of suspected coronary artery disease

作　　者：石亚君[1] 牛卢芳[1,2] 吴传勇[1,2] 郜玲[1] 马一鸣[1] 郭亚涛[1] 王晋丽[1] 卢喜烈[1] 陈韵岱[1] 

机构地区：[1]解放军总医院心内科心脏无创检测中心,北京100853 [2]汕头大学医学院

出　　处：《中华老年心脑血管病杂志》2012年第8期814-816,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家科技支撑计划(2009BAI04)

摘　　要：目的分析心肌缺血总负荷(TIB)单独或联合冠心病危险因素对可疑冠心病患者的诊断价值。方法选择可疑冠心痛患者89例,同期行同步动态心电图监测及冠状动脉造影(CAG)后将患者分为:CAG阳性组52例,CAG阴性组37例。对2组TIB及危险因素进行logistic回归分析,计算TIB和(或)有意义指标检出冠心病的敏感性、特异性、阳性预测值和阴性预测值。结果 TIB检测冠心病的敏感性32.7%,特异性84.5%,阳性预测值77.3%,阴性预测值47.8%;男性与TIB阳性比较,诊断冠心病的敏感性升高(P<0.01);TIB阳性+糖尿病与TIB阳性比较,敏感性降低、特异性及阳性预测值升高(P<0.05,P<0.01)。年龄、男性和糖尿病是冠心病的独立危险因素。结论中老年男性及糖尿病患者发生冠心病的危险性明显升高;TIB与相关危险因素联合可以提高冠心病的诊断价值。在对可疑冠心病患者进行鉴别诊断时,TIB阳性、中老年男性及糖尿病具有重要参考价值。Objective To study the value of total ischemia burden（TIB）,single or several risk fac tors for the diagnosis of suspected coronary artery disease（CAD）. Methods Eighty-nine suspec- ted CAD patients, who underwent 12-lead dynamic electrocardiogram and coronary angiography （CAG） within one week,were divided into positive CAG group（n：52） and negative CAG group （n=37） according to their CAG findings. TIB and risk factors in the two groups were analyzed by logistic regression analysis. Specificity, sensitivity, positive and negative predicting value of TIB and/or significant indications for the diagnosis of CAD were calculated and compared. Results The specificity, sensitivity,positive and negative predicting value of TIB for the diagnosis of CAD were 32.7%,84.5%,77.3% and 47.8%,respectively. The sensitivity of positive TIB for the di- agnosis of CAD was higher in males than in females（P〈0.01）. The sensitivity of positive TIB ~ diabetes mellitus（DM） was lower while their specificity and positive predicting value were higher than those of positive TIB alone（P〈0. 05, P〈0. 01）. Logistic regression analysis showed that age,male and DM were the independent risk factors for CAD. Conclusion The risk of developing CAD increases significantly in middle-aged and elderly males and DM patients. TIB and relevant risk factors improve the diagnosis of CAD. Positive TIB, middle-aged and elderly males, and DM are of important reference value for the differential diagnosis of suspected CAD.

关 键 词：心肌缺血 冠心病 冠状血管造影术 心电描记术 便携式 糖尿病 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]