多巴酚丁胺负荷超声心动图检测病变冠状动脉的临床研究  

Clinical research on dobutamine stress echocardiography for evaluating diseased coronary artery

作　　者：杨青苗[1] 王国宏[1] 边红[1] 李洁[1] 王淑敏[1] 周岩[1] 

机构地区：[1]首都医科大学附属北京同仁医院心血管疾病诊疗中心,北京100730

出　　处：《山西医科大学学报》2014年第12期1172-1176,共5页Journal of Shanxi Medical University

摘　　要：目的通过观察多巴酚丁胺负荷超声心动图(DSE)诱发的节段性室壁运动异常(RWMA),从而分析和判定病变的冠状动脉,为临床选择治疗方案和评价预后提供依据。方法对临床疑诊冠心病(CAD)的78例患者均行冠状动脉造影(CAG)和DSE检查,并比较DSE与CAG检查结果,判定其检测的临床价值。结果 DSE检测单支病变的敏感性为78.05%,符合率为60.98%。DSE检测双支病变的敏感性为81.81%,检测三支病变的敏感性为100%;DSE检测多支病变的符合率为35.29%。DSE检测左前降支(LAD)、左回旋支(LCX)和右冠脉(RCA)病变的敏感性分别为65.8%,26.1%和66.7%(P<0.01);特异性和准确性差异无显著性(P>0.05)。检测出RCA和LAD病变的敏感性高于LCX(P<0.01)。DSE试验峰值负荷时CAD组和正常对照组WMSI比较差异有显著性(P<0.01),而DSE峰值负荷时单支和多支病变组RWMA比较差异无显著性(P=0.147)。结论 DSE检测CAD患者的RWMA有较高的敏感性和特异性,可无创估测病变冠状动脉,对RCA、LAD的敏感性高于LCX,对临床进行CAG的筛选具有重要意义。半定量的WMS和WMSI值的高低能说明左心室收缩功能的好坏,但并不能区分是单支病变还是多支病变。Objective To investigate the regional wall motion abnormalities （RWMA）induced by dobutamine stress echocardiography（DSE） for evaluating the diseased coronary artery,and thus providing the basis for the treatment and prognosis evaluation.Methods DSE and coronary angiography （CAG）were performed in 78 patients with clinically suspected coronary artery disease （CAD） to observe the location and scope of RWMA and calculate the wall motion score（WMS） and wall motion score index（WMSI）.Results The sensitivity of DSE for single lesion was 78.05％,and the coincidence rate with CAG was 60.98％.The sensitivity of DSE was 81.8％ for detecting double branches lesions and 100％ for three branches lesions.The coincidence rate with CAG was 35.29％ for detecting the multivessel lesions.The sensitivity of DSE was 65.8 ％,26.1％ and 66.1％ for detecting LAD,LCX and RCA,respectively （P ＜ 0.01）,while there was no significant difference in specificity and accuracy （P ＞ 0.05）.There was significant difference in WMSI at DSE peak load between CAD group and normal control group（P ＜ 0.01）,and there was no significant difference in RWMA between single and multiple lesions at DSE peak load（P =0.147）.Conclusion DSE has higher sensitivity and specificity to detect the RWMA in CAD patients and is a noninvasive method to estimate lesions of coronary artery.The sensitivities to RCA and LAD are higher than that of LCX,and that is of great significance for clinical screening of CAG.The semi-quantitative WMS and WMSI values can indicate the level of left ventricular systolic function,but could not distinguish single lesion from multivessel lesions.

关 键 词：超声心动图 多巴酚丁胺负荷 节段性室壁运动异常 冠心病 冠状动脉造影术 

分 类 号：R540.45[医药卫生—心血管疾病]