运动平板试验Duke评分对胸痛患者危险分层及预后的价值  

Value of the Duke treadmill score for risk stratification and prognosis in patients with acute chest pain

作　　者：王爱萍[1] 侯瑞[1] 张焕轶[1] 吴云[1] 王华义 王欣[3] 

机构地区：[1]泰安市中心医院心内科,山东泰安271000 [2]莱芜市疾病控制中心,山东莱芜271100 [3]泰安市中心医院彩超室,山东泰安271000

出　　处：《实用医药杂志》2014年第3期193-196,共4页Practical Journal of Medicine & Pharmacy

摘　　要：目的 评价运动平板试验Duke评分（DTS）对胸痛患者危险分层及预后评估的应用价值.方法选择169例运动试验阳性和可疑阳性同时行冠状动脉造影的患者为研究对象,按Duke评分分为DTS低危组（Duke≥5分,n＝35）、中高危组（DTS＜＋5,n＝134）,比较两组患者冠状动脉病变和临床特点,随访两年比较2组发生主要不良心血管事件（MACE）的概率,分析DTS预测MACE的价值.结果在中高危组中限制性心绞痛发作例数、ST段偏移≥1 mm例数、运动时ST段改变涉及导联数目、ST段偏移值均明显高于DTS低危组（P＜0.05）;而运动持续时间和运动最大心率明显低于DTS低危组（P＜0.05）.DTS与冠脉病变的严重程度相关,冠脉造影结果显示低危组冠脉造影Gensini积分低于中高危组（P＜0.0001）;胸痛患者有随访资料的169例,失访9例,160例完成随访,失访率为5.33%.MACE主要发生在随访1个月,在DTS中高危组中发生MACE明显高于DTS低危组（P＜0.05）;logistic多因素回归分析显示,DTS是心血管事件发生的危险因素（OR＝1.434,1.278～1.609;Wald χ2＝37.7076,P＜0.0001）.结论运动试验DTS与冠状动脉病变狭窄程度高度相关;DTS中高危组发生MACE明显高于低值组,应用该评分可以有效地对临床中胸痛患者进行危险分层及预后的评估,对于DTS中高危组的患者应迅速进行评估并考虑早期行再灌注治疗.Objective To assess the Duke treadmill score for risk stratification and prognosis in patients with chest pain,and investigate value of those methods in predicting clinical events of patients. Methods The 169 patients with exercise in positive or dubitable positive TET who underwent coronary angiography （CAG） in Tai＇an Central Hospital were enrolled in this study. According to the value of DTS,all patients were divided into 2 groups by the Duke treadmill score： low-risk（DTS≥＋5,n＝35） and moderate/high-risk DTS groups（DTS＜＋5,n＝134）,the correlation between DTS and coronary angiography Gensini score was evaluated. The patients were followed up for 2 years,the main adverse cardiovascular events（MACE） were observed and recorded,and DTS was used to evaluate the value of MACE. Duke formula： treadmill score＝（exercise duration in minutes）-（5×ST-segment deviation in millimeters）-（4×treadmill angina index）,where the treadmill angina index＝0 for no exercise angina,1 for exercise angina and 2 for exercise-limiting angina. The results were analyzed and proecssed with SAS8.1 statistically. Results In the moderate/high-risk group,the restrictive angina attack case number,ST-segment deviation≥1 mm number of cases,ST segment changes in exercise involving a number of leads,ST-segment deviation values were significantly higher than the DTS low-risk group（P＜0.05）;and the exercise duration and maximum heart rate were significantly lower than DTS low-risk group（P＜0.05）. DTS and the severity of coronary lesions,coronary angiography results showed that the Gensini score was lower than low-risk group of coronary angiography in moderate/high-risk group（P＜0.0001）. The 169 chest pain patients had followed-up data,9 patients were lost,the follow-up,the rate was 5.33%. MACE occurred in first follow-up month,the moderate/high risk cases in the MACE were significantly higher than in the DTS low-risk group（P＜0.05）;By the logistic multivariate regression analysis, DTS was

关 键 词：运动平板试验 DUKE评分 冠状动脉造影积分 冠心病 预后 

分 类 号：R541.4[医药卫生—心血管疾病] R540.47[医药卫生—内科学]