平板运动试验与生化指标诊断可疑冠心病  

Analysis of treadmill exercise test parameters and biomarkers for the diagnosis of inconclusive coronary heart disease

作　　者：逯丹[1] 麦鸿成 徐安定[1] 夏纪田[1] 张涛[1] 

机构地区：[1]暨南大学第一附属医院,510632

出　　处：《临床心电学杂志》2015年第3期181-184,共4页Journal of Clinical Electrocardiology

基　　金：广州市科技计划(No.40108003);中央高校基础研究基金(No.21611333)

摘　　要：目的对可疑冠心病患者评估平板运动实验(TET)参数及生化指标以提高其诊断效果。方法对68例非外周动脉疾病、肌病以及肾功能不全的患者进行TET检测。然后对其TET参数和生化指标进行计算,并在一个月内进行冠脉穿刺(CAG)确诊,从而确定CHD患者的诊断点,为CHD提供诊断方法。结果通过对TET各指标分析得出最大心率(Peak HR),最大心率达标率(MPHR),低密度脂蛋白(LDL)以及糖化血红蛋白(HbA1c))有显著统计学意义(p<0.05)。最终通过逐步回归分析得出TET结合MPHR和HbA1c的等式[p=1/[1+e-(-4.036+0.367X1-0.118X2+2.807X3)];X1:TET;X2:MPHR achieved;X3:HbA1c]能够较单独TET测量提高诊断CHD的水平。经ROC曲线分析,其ROC下的面积为0.822。通过线性内插法求出诊断点为p=0.824。也就是说,当p大于0.824时,该病患可以诊断为CHD,反之亦然。结论MPHR以及HbA1c与TET结果结合对可疑TET患者有提高诊断的效果,不仅能够减少CAG造成的侵入性损伤,也能提高并明确可疑CHD。通过对TET可疑阳性的检测,证明该诊断点对可疑TET阳性患者诊断的敏感度为50%,假阳性率为0%。Objective The purpose of this study was to estimate some treadmill exercise test parameters and biomarkers for the diagnosis of inconclusive coronary heart disease （CHD） patients during noninvasive treadmill exercise test （TET）. Methods We followed 68 individuals without peripheral artery disease, myopathy and renal function insufficiency for clinical TET. Then we measured TET parameters and biomarkers of them who had invasive Coronary angiography （CAG） within one month, and analyzed the effective detection for suspected CHD patients to confirm the diagnosis points. Results We had chosen Peak HR （Heart rate）, MPHR （maximum peak heat rate） achieved, LDL （low density lipoprotein） and HbA1c （Glycated hemoglobin） to study since they has different between positive and negative groups. The equation of the results of TET combined with MPHR achieved and HbA1c was： p = 1/[l＋e- （-4.036＋0.367X1-0.118X2＋2.807X3）]; Xl： TET; X2： MPHR achieved; X3： HbA1c. Area under the receiver operating characteristic （ROC） curve was 0.822. The diagnosis point was 0.824 when the false positive rate was R = 5.00%. So, if there was an inconclusive patient, p （R = x） was calculated to higher than 0.824, he/she was CHD patients; and vice versa. Conclusions MPHR achieved and HbA1c were combined TET to diagnosis inconclusive TET patients, not only decreasing invasive damage, but also promoting and confirming the diagnosis of suspected CHD patients which in our study of inconclusive TET patient, the sensitivity was 50% and the false positive rate was 0%.

关 键 词：平板运动实验 冠脉造影 ROC曲线 糖化血红蛋白 

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