运动平板试验对冠心病诊断价值的研究  

Clinical value of treadmill exercise test with coronary angiography in patients with coronary artery diseases

作　　者：翟真[1] 唐熠达 王丽[1] 康秀华[1] 韩龙飞 ZHAI Zhen;TANG Yi-da;WANG Li(Department of Cardiology,Yuquan Hospital of Tsinghua University,Beijing 100040,China;Coronary Heart Disease Center,Fuwai Hospital,CAMS,NCCD,Beijing 100037,China.)

机构地区：[1]清华大学玉泉医院心血管疾病科,北京100040 [2]国家心血管病中心中国医学科学院阜外医院冠心病中心,北京100037

出　　处：《临床和实验医学杂志》2018年第18期1971-1973,共3页Journal of Clinical and Experimental Medicine

基　　金："十二五"国家科技支撑计划项目(编号:2015BAI12B01)

摘　　要：目的探讨运动平板试验(TET)对冠心病诊断的临床应用价值。方法回顾性分析清华大学玉泉医院及阜外医院2016年1月至2017年8月收治的有胸闷、胸痛症状拟诊为冠心病、进行平板运动试验及冠状动脉造影(CAG)的208例患者,计算平板运动试验诊断冠心病的敏感性、特异性、准确性。分析运动平板试验真阳性患者冠脉病变严重程度及累及支数。并对TET发生ST段压低的导联与冠状动脉病变部位的关系进行对比。结果 (1)TET阳性110例患者中,CAG阳性73例,阴性37例。TET阴性98例患者中,CAG阳性15例,阴性83例。TET诊断冠心病的敏感性为83.0%,特异性为69.2%,准确性为75.0%;TET的敏感性、准确性较高,但特异性较低。(2)TET真阳性患者中冠状动脉为中重度病变的人数显著多于轻度病变(P<0.05)。(3)TET真阳性患者中冠状动脉多支病变的人数显著多于单支病变(P<0.05)。(4)胸前导联V4~V6导联ST段改变者,CAG前降支病变率明显高于其他导联ST段改变者(P<0.05);下壁导联Ⅱ、Ⅲ、aVF导联ST段改变者,CAG右冠脉病变率明显高于其他导联ST段改变者(P<0.05)。结论 TET对评价冠心病具有较高的敏感度,可对冠状动脉病变部位和病变程度进行一定的预判。Objective To explore the clinical value of treadmill exercise test（TET） in patients with coronary heart disease（CHD）.Methods Retrospective study of 208 patients with chest tightness and chest pain suspected with CHD was conducted. All the patients came from Yuquan Hospital of TSinghua University and Fuwai hospital,from January 2016 to August 2017,and were examined by TET and coronary angiography（CAG）. The sensitivity,specificity and diagnostic accuracy of TET were calculated. Severity and number of coronary artery lesions in true positive patients. Compared the relationship between the lead of TET ST depression and the location of coronary artery lesion. Results （1）Among110 patients with positive diagnosis by TET,73 patients had positive and 37 patients had negative result of CAG. Among 98 patients with negtive diagnosis by TET,15 patients had positive and 83 patients had negative result of CAG. The sensitivity,specificity,accruacy,were 83. 0 %,69. 2 %,75. 0 %. The sensitivity and accuracy of TET in diagnosis of CHD are high,but the specificity is low.（2）Most of the patients with true-positive result of TET had severe lesions of coronary artery（P〈0. 05）.（3）Most of the patients with true-positive result of TET had multiple vessel disease（P〈0. 05）.（4）The lead（V4- V6） ST segment changes of left anterior descending branch of the anterior wall of group were significantly higher than those of other lead ST segment changes（P〈0. 05）. The inferior（Ⅱ,Ⅲ,a VF） ST segment changes of right coronary group were significantly higher than those of other lead ST segment changes（P〈0. 05）. Conclusion TET has high sensitivity to the evaluation of CHD and can predict the location and degree of coronary artery lesions.

关 键 词：冠心病 平板运动试验 冠状动脉造影 

分 类 号：R541.4[医药卫生—心血管疾病]