冠心病患者心电图ST段改变与多排螺旋CT冠状动脉成像的关系分析  

Relationships between ECG ST-segment changes and multi-slice spiral CT coronary angiography in patients with coronary heart disease

作　　者：文翠[1] 赵新军[2] 张震洪[3] 袁健祥[4] 王文会[5] WEN Cui;ZHAO Xinjun;ZHANG Zhenhong;YUAN Jianxiang;WANG Wenhui(Department of Functional Examination,Foshan Hospital of TCM,Foshan 528000,China;Department of Cardiovascular Medicine,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510000,China;Department of Cardiovascular Medicine,the Second People's Hospital of Foshan City,Foshan 528000,China;CT Room,Foshan Hospital of TCM,Foshan 528000,China;Department of Cardiovascular Medicine,Foshan Hospital of TCM,Foshan 528000,China)

机构地区：[1]佛山市中医院功能检查科,广东佛山528000 [2]广州中医药大学第一附属医院心血管内科,广东广州510000 [3]佛山市第二人民医院心血管内科,广东佛山528000 [4]佛山市中医院CT室,广东佛山528000 [5]佛山市中医院心血管内科,广东佛山528000

出　　处：《中国医学物理学杂志》2020年第8期1035-1039,共5页Chinese Journal of Medical Physics

基　　金：广东省医学科研基金(A2017550)。

摘　　要：目的:通过对心电图ST段改变及多排螺旋CT冠状动脉成像(MSCTCA)检查在冠心病诊断中的比较分析,探讨冠心病诊断中心电图和MSCTCA检查的方法和作用,为临床诊断提供更多有效的信息。方法:选取临床诊断疑似或确诊为冠心病患者64例,进行心电图和MSCTCA检查,比较两种方法的一致性,不同部位、不同程度及不同类型病变检查的阳性率。结果:与MSCTCA方法相比,心电图ST段改变检查的灵敏度为56.82%,特异度为50%,总体符合率为54.69%,Kappa值为0.061,两种方法检查一致性较差,差异具有显著性(P<0.05);Ⅰ/avL/V1-5导联ST段改变阳性患者与Ⅱ/Ⅲ/avF导联ST段改变阳性患者相比,以MSCTCA检查的阳性率更高(P<0.05);冠状动脉重度狭窄患者与轻度患者相比,心电图ST段改变阳性率显著升高(P<0.05);中度狭窄患者与轻度患者相比,心电图ST段改变阳性率差异不显著(P>0.05);多支冠状动脉病变患者心电图ST段改变阳性率显著高于单支管状动脉病变患者(P<0.05)。结论:心电图与MSCTCA检查一致性较差,临床上不宜单独使用单一检查方法;在重度冠状动脉狭窄患者及多支冠状动脉病变患者中,心电图ST段改变检出率较高,结果具有参考价值;Ⅰ/avL/V1-5导联ST段改变阳性患者相比Ⅱ/Ⅲ/avF导联ST段改变阳性患者,MSCTCA检查阳性率更高,更具有检测意义。Objective To explore the methods and roles of electrocardiogram(ECG)and multi-slice spiral CT coronary angiography(MSCTCA)in the diagnosis of coronary heart disease(CHD)by comparing and analyzing ECG ST-segment changes andMSCTCA,thereby providing more effective information for the clinical diagnosis of CHD.Methods A total of 64 patients with suspected or confirmed CHD by clinical diagnosis underwent ECG and MSCTCA.The examination consistency between two methods was compared,and the positive rates of two methods in the examination of lesions of different parts,different degrees and different types were also compared.Results Compared with MMSCCA,ECG ST-segment changes had a sensitivity,specificity and overall coincidence rate of 56.82%,50%and 54.69%,respectively.The test consistency between two methods was poor(Kappa=0.061,P<0.05).The positive rate of MSCTCAin patients with positive Ⅰ/avL/V1-5 lead ST-segment changes and those with positive Ⅱ/Ⅲ/avF lead ST-segment changes was significantly higher(P<0.05),while the positive rate of ECG ST-segment changes in patients with severe and mild coronary artery stenosis was significantly increased(P<0.05).The positive rate of ECG ST-segment changes in patients with moderate coronary stenosis was similar to that in patients with mild coronary stenosis(P>0.05),but the positive rate of ECG-ST segment changes in patients with multiple-vessel coronary artery lesions was significantly higher than that in patients with single-vessel coronary artery lesions(P<0.05).Conclusion The consistency between ECG and MSCTCA is poor.In clinic,it is not appropriate to adopt ECG or MSCTCA alone.ECG ST segment changes have higher detection rates in patients with severe coronary artery stenosis and those with multiple-vessel coronary artery lesions,while MMSCCAhas higher detection rates in patients with postitive Ⅰ/avL/V1-5 lead ST-segment changes and those with positive Ⅱ/Ⅲ/avF leads ST-segment changes.

关 键 词：冠心病 心电图 多排螺旋CT 冠状动脉成像 

分 类 号：R541.1[医药卫生—心血管疾病]