更新的Diamond-Forrester法和Duke临床评分预测模型对可疑冠心病患者的诊断价值  

Diagnostic Value of Updated Diamond- Forrester Method and Duck Clinical Score Prediction Model in Patients With Suspected Coronary Artery Disease

作　　者：贺婷[1] 刘星[1] 李莹[1] 吴俏玉[1] 罗爱静[1] 袁洪[1] 

机构地区：[1]中南大学湘雅三医院,湖南省长沙市410013

出　　处：《中国全科医学》2016年第20期2440-2444,共5页Chinese General Practice

基　　金：国家"重大新药创制"科技重大专项(2012ZX09303014001);中南大学湘雅大数据;湖南省科技计划国际合作重点项目(2014W2034)

摘　　要：目的比较更新的Diamond-Forrester法（UDFM）和Duke临床评分（DCS）两种预测模型对我国可疑冠心病患者评估的准确性,并进一步分析两者在不同性别之间准确性的差异。方法选取2010年1月—2015年5月因胸痛在中南大学湘雅三医院心内科行冠状动脉造影（CAG）的患者1 311例。分别利用UDFM、DCS估算患者的验前概率（PTP）,并分为低（〈30%）、中（30%～70%）、高（〉70%）PTP组,高PTP组即认为患有冠心病。以CAG为金标准,分析UDFM、DCS对我国可疑冠心病患者诊断的准确性,并进一步分析两者在不同性别之间准确性的差异。结果 CAG结果显示,739例（56.37%）患者确诊为冠心病。UDFM结果显示,294（22.43%）、673（51.33%）、344（26.24%）例患者分别纳入低、中、高PTP组;DCS结果显示,165（12.59%）、403（30.74%）、743（56.67%）例患者分别纳入低、中、高PTP组。两者PTP分布比较,差异有统计学意义（χ2=379.00,P〈0.001）。在确诊的739例患者中,UDFM将125（16.91%）、372（50.34%）、242（32.75%）例患者分别纳入低、中、高PTP组,DCS将64（8.66%）、189（25.58%）、486（65.76%）例患者分别纳入低、中、高PTP组,两者确诊患者PTP分布比较,差异有统计学意义（χ2=257.00,P〈0.001）。以CAG为金标准,UDFM诊断冠心病的灵敏度为32.8%,特异度为82.2%,正确率为54.3%,受试者工作特征（ROC）曲线下面积为0.64〔95%CI（0.61,0.67）〕;DCS诊断冠心病的灵敏度为65.8%,特异度为55.1%,正确率为61.1%,ROC曲线下面积为0.63〔95%CI（0.60,0.66）〕。两者ROC曲线下面积比较,差异无统计学意义（Z=0.33,P〉0.05）。UDFM对男性典型胸痛患者、不典型胸痛患者、非心绞痛型胸痛患者计算的PTP与实际阳性率较接近,而对女性患者,除50～59岁典型心绞痛患者存在高估现象外,余均存在低估现象;DCS对男性患者存在高估现象,对女性患者,除典型心绞痛患者存在高估现象外,Objective To compare the evaluation accuracy of the two prediction models updated Diamond - Forrester method （UDFM） and Duke clinical score （DCS） for patients with suspected coronary artery disease in China, and further analyze their accuracy differences between different genders. Methods 1 311 patients who had underwent CAG surgery because of chest pain in the Department of Cardiology of the Third Xiangya Hospital of Central South University from January 2010 to May 2015 were enrolled in this study. UDFM and DCS were employed to estimate the pretest probability （PTP） of the patients respectively, and PTP was divided into three groups, which were low PTP （ 〈 30% ） , medium PTP （30% -70% ） and high PTP （ 〉70% ） groups; patients in the high PTP group were taken as having coronary artery disease. Taking CAG as the golden standard, we analyzed the diagnostic accuracy of UDFM and DCS in patients with suspected coronary artery disease in China, and further analyzed the accuracy differences of these two models between different genders. Results Of the 1 311 patients, CAG result displayed that 739 （ 56. 37% ） cases were confirmed as coronary artery disease. UDFM result showed that 294 （22. 43% ）, 673 （51.33%） and 344 （26. 24% ） cases were grouped into low PTP, medium PTP and high PTP respectively;- DCS result demonstrated that 165 ~12. 59% ） , 403 （30. 74% ） and 743 （56. 67% ） eases fell into the groups of low PTP, medium PTP and high PIP. The two PTP distribution comparisons showed significant difference （ X2 = 379. 00, P 〈 0. 001 ）. Of the confirmed 739 cases, UDFM brought 125 （ 16. 91% ） , 372 （50. 34% ） and 242 （32. 75% ） cases into the low PTP, medium PTP and high PTP groups, while 64 （8.66%）, 189 （25.58%） and 486 （65.76%） were classified into the groups of low PTP, medium PTP and high PTP by DCS, and the PTP distribution comparison of the confirmed patients of the two showed significant difference （ X2 = 257.00, P 〈 0. 001 ）.

关 键 词：冠心病 验前概率 冠状血管造影术 诊断 灵敏度 特异度 更新的Diamond-Forrester法 Duke临床评分 

分 类 号：R541.4[医药卫生—心血管疾病]