动态心电图和CT首过心肌灌注成像在冠心病心肌缺血诊断中的对比分析  

Comparison study between dynamic electrocardiogram and CT First-pass myocardial perfusion imaging in diagnosing myocardial ischemia

作　　者：董小波[1] 王颖[2] 于秀艳 张仲慧[1] 汤建中[1] 

机构地区：[1]开滦总医院核医学科,河北唐山063000 [2]开滦总医院腔镜诊疗部,河北唐山063000 [3]河北省唐山市曹妃甸区医院放射科,河北唐山063000

出　　处：《中国医药导报》2017年第7期110-113,共4页China Medical Herald

摘　　要：目的评价动态心电图(DCG)和CT首过心肌灌注成像诊断冠心病心肌缺血的价值。方法选取2014年2月~2015年1月在开滦总医院疑诊冠心病患者55例,所有患者行DCG、冠状动脉CT成像(CCTA)、核素心肌灌注显像(MPI)检查。以MPI为参考标准,比较DCG、CT首过心肌灌注成像诊断心肌缺血的敏感性、特异性、阳性预测值、阴性预测值、准确性及其与MPI诊断结果的一致性。结果 55例患者完成检查。DCG诊断心肌缺血的敏感性69.70%(23/33),特异性72.73%(16/22),阳性预测值79.31%(23/29),阴性预测值61.54%(16/26),准确性70.91%(39/55),DCG与MPI结果的一致性Kappa=0.412(P<0.05);CT首过心肌灌注成像诊断心肌缺血的敏感性90.91%(30/33),特异性77.27%(17/22),阳性预测值85.71%(30/35),阴性预测值85.00%(17/20),准确性85.46%(47/55),CT首过心肌灌注成像与MPI结果的一致性Kappa=0.692(P<0.05)。结论 CT首过心肌灌注成像在诊断冠心病心肌缺血方面比DCG更有优势。Objective To evaluate dynamic electrocardiogram （DCG） and CT firs-pass myocardial perfusion imaging for diagnosis of myocardial ischemia in coronary artery disease. Methods From February 2014 to January 2015, in Kailuan General Hospital, 55 patients with suspected or diagnosed coronary artery disease were selected. DCG, coronary computed tomography angiography （CCTA） and myocardial perfusion imaging （MPI） were performed in all patients. MPI was as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of DCG and CT first-pass myocardial perfusion imaging in the diagnosis of myocardial ischemia were evaluated, and the consistency with the diagnosis of MPI were analyzed. Results All patients had successfully completed the examination. The sensitivity, specificity, positive predictive value and negative predictive value of DCG in diagnosis myocardial ischemia were 69.70%（23/33）, 72.73% （16/22）, 79.31% （23/29） and 61.54% （16/26） respectively, the accuracy was 70.91%（39/55）, the consistency between DCG and MPI Kappa = 0.412 （P 〈 0.05）. The sensitivity, specificity, positive predictive value and negative predictive value of CT first-pass myocardial perfusion imaging in diagnosis myocardial ischemia were 90.91%（30/33）, 77.27% （17/22）, 85.71% （30/35） and 85.00% （17/20） respectively, the accuracy was 85.46%（47/55）. The consistency between CT first-pass myocardial perfusion imaging and MPI Kappa = 0.692 （P〈 0.05）. Conclusion CT first-pass myocardial perfusion imaging has more advantages than DCG in the diagnosis of coronary heart disease myocardial ischemia.

关 键 词：心肌缺血 动态心电图 体层摄影术 X线计算机 心肌灌注显像 

分 类 号：R542.2[医药卫生—心血管疾病] R540.41[医药卫生—内科学]