腺苷超声心动图负荷试验诊断冠心病的应用价值  

The Value of Adenosine Stress Echocardiography in Diagnosis of Coronary Artery Disease

作　　者：张彦[1] 朱文玲[1] 郭丽琳[1] 倪超[1] 邓重信[2] 姜乃琴[2] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院,100730 [2]辽宁省人民医院

出　　处：《中国超声医学杂志》2001年第5期340-343,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 :评价腺苷超声心动图负荷试验诊断冠心病的敏感性、特异性和安全性。方法 :6 0例临床拟诊冠心病 (CAD)的患者 ,分别静脉注射腺苷造成心肌缺血 ,注射剂量为 140 μg/ kg/ min,用药时间 6分钟 (总剂量 0 .8mg/kg)。注射过程中观察和记录室壁运动变化 ,患者症状、血压和心率。左室 16节段中出现室壁运动异常 (WMA)为阳性。心电图阳性标准是 ST段下降 0 .1m V。试验后一周内行冠脉造影 ,以三条主要血管至少有一支或主要初发支管径狭窄≥ 5 0 %为阳性。以冠脉造影为金标准 ,计算腺苷负荷试验敏感性和特异性等。结果 :2 6例确诊为 CAD的患者中腺苷负荷试验阳性 2 4例 ,腺苷负荷心电图阳性 11例。另外 34例冠脉造影正常的患者中有 6例为腺苷负荷试验阳性。冠脉造影见病变血管 45支 ,正常 135支 ,腺苷负荷试验阳性血管 34支 (其中 2 8支与冠造相符合 ) ,阴性 146支。腺苷超声心动图诊断 CAD的敏感性为 92 .3% ,特异性为 82 .3%及准确度为 86 .7%。腺苷负荷试验判断血管病变的敏感性为 6 2 .2 % ,特异性 94.8% ,阳性预测值 80 .0 % ,阴性预测值 88.3%和准确度为 86 .7% ;诊断 CAD单支、双支和三支病变的敏感性分别为 83.3% ,10 0 %和 10 0 %。不良反应发生率为 73.3% ,但症状轻微 ,患者均能耐受 。Objective:The aims of the study were to assess the value of adenosine stress echocardiography in diagnosis of CAD and to determine the sensitivity,specificity and accuracy by the golden criterion of coronary angiography.Methods:Adenosine stress echocardiography was performed in 60 suspectable CAD patients using infusion dose of 140μg/kg/min in 6 min.Left ventricular wall motion was recorded during the procedure.Positive criterion was defined as the appearance of wall motion abnormality(WMA).Results:Adenosine stress echocardiography was positive in 24 out of 26 CAD patients and 6 out of 34 normal patients.The total sensitivity of this test was 92 3% and the total specificity was 82 3%.The sensitivity for detection of each coronary artery lesion was 62 2% and the specificity was 94 8%.Furthermore the sensitivity for detection of myocardial ischemia in one,two and three vessel CAD subgroups were 83 3%,100% and 100% respectively.Side effects due to adenosine infusion were always minimal and well tolerated by the patients and disappeared within seconds after termination of infusion.Conclusions:Adenosine stress echocardiography can be safely performed in suspectable CAD patients with high sensitivity and specificity.

关 键 词：腺苷 超声心动图负荷试验 室壁运动异常 冠心病 诊断 

分 类 号：R541.4[医药卫生—心血管疾病] R540.45[医药卫生—内科学]