多种无创检查组合在冠心病诊断中的价值  

The Value of Various Combinations of Non-invasive Examinations in the Diagnosis of Coronary Artery Disease

作　　者：于海波[1] 韩雅玲[1] 荆全民[1] 刘海伟[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,辽宁沈阳110016 [2]北京大学第一医院心内科,北京110034

出　　处：《现代生物医学进展》2014年第9期1668-1670,1656,共4页Progress in Modern Biomedicine

基　　金："十一五"国家科技支撑计划项目(2006BAI01A02)

摘　　要：目的:评价多种无创辅助检查组合对冠状动脉粥样硬化性心脏病(冠心病)辅助诊断价值,筛选有效的冠心病确诊和排除指标,初步确定优化的冠心病早期诊断策略。方法:回顾性分析6419例冠心病患者多项无创辅助检查结果(包括静息心电图、24小时动态心电图、负荷心电图、负荷核素心肌显像、16或64排CT冠状动脉成像),以冠状动脉造影阳性(至少一支主要冠状动脉或其主要分支的内径有≥50%的狭窄)为金标准,观察各种无创辅助检查组合对冠心病诊断的特异性、敏感性、误诊率、漏诊率、阳性预测值和阴性预测值。结果:多项无创辅助检查组合在冠心病的诊断中敏感性56.02-87.43%,特异36.13-87.61%,阳性预测值58.83-97.16%,阴性预测值30.21-73.36%,非介入手段中,敏感性和阴性预测值以动态心电图联合核素心肌灌注显像组最高,特异性和阳性预测值以动态心电图联合冠脉CT成像组最高。结论:辅助检查组合可作为无创性诊断、评价冠心病的重要方法,动态心电图可作为各级别医院冠心病筛查的基本及重要手段。Objective： Evaluate the diagnostic value of various combinations of non-invasive laboratory examinations of coronary atherosclerotic heart disease （CHD）, screening of the effective coronary heart disease diagnosis and exclusion of indicators, to initially de- termine the optimal strategy for early diagnosis of coronary artery disease. Methods： Analyze a number of non-invasive ancillary test results （including resting ECG, Holter, stress ECG, myocardial perfusion imaging load, 16 or 64-slice CT coronary angiography） in 6419 patients of coronary heart disease, the abnormality of coronary angiography （at least a major coronary artery or its major branches are ≥ 50% diameter stenosis） as the gold standard, observing the combination of a variety of non-inva sive laboratory examination in the diagnosis of coronary heart diseases in specificity, sensitivity, misdiagnosis rate and rate of missed diagnosis, positive predictive value and negative predictive value. Results： ensitivity 56.02-87.43%, specificity： 36.13-87.61%, positive predictive value： 58.83-97.16%, negative predictive value： 30.21-73.36%, In non-invasive means, the sensitivity and negative predictive value was the highest in the Holter monitoring combined with myocardial perfusion imaging group, specificity and positive predictive value was the highest, in the Holter combined with coronary CT imaging group. Conclusion： Combination of auxiliary examination can be used as an important method of non-invasive diagnosis and the evaluation of coronary heart disease, Holter can be considered as basic and important mean of screening in coronary heart disease at all levels of hospital.

关 键 词：静息心电图(RECG) 发作心电图(AECG) 24小时动态心电图(Holter) 运动平板心电图(TET) 多层螺旋CT(MSCT) 核素心肌灌注显像(SPECT) 冠状动脉造影(CAG) 冠心病(CAD) 

分 类 号：R541.4[医药卫生—心血管疾病]