心肌声学造影与经胸超声心动图对心肌缺血患者冠状动脉狭窄诊断价值的对比研究  

Comparative Study of the Diagnostic Value of Myocardial Contrast Echocardiography and Transthoracic Echocardiography on Coronary Arteriostenosis in Patients with Myocardial Ischemia

作　　者：赵欣[1] 张雪梅[1] 程功[2] 赵颖[1] 娄萍 ZHAO Xin;ZHANG Xuemei;CHENG Gong;ZHAO Ying;LOU Ping(Ultrasonic Diagnostic Center,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Second Department of Cardiology,Shaanxi Provincial People's Hospital,Xi'an 710068,China)

机构地区：[1]陕西省人民医院超声诊断中心,陕西省西安市710068 [2]陕西省人民医院心血管内二科,陕西省西安市710068

出　　处：《实用心脑肺血管病杂志》2020年第9期96-99,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：陕西省重点研发计划项目(2019SF-191)。

摘　　要：目的比较心肌声学造影(MCE)与经胸超声心动图(TTE)对心肌缺血患者冠状动脉狭窄的诊断价值。方法选取2019年1—6月陕西省人民医院心血管内科收治的心肌缺血患者37例,患者入院后陆续行TTE、MCE及冠状动脉造影(CAG)检查。以CAG检查结果作为诊断冠状动脉狭窄的“金标准”,比较TTE、MCE诊断心肌缺血患者冠状动脉狭窄及重度狭窄的正确率、灵敏度及特异度,并绘制受试者工作特征曲线(ROC曲线),计算二者诊断心肌缺血患者冠状动脉狭窄及重度狭窄的曲线下面积(AUC)。结果TTE对心肌缺血患者冠状动脉狭窄的诊断正确率为75.7%(476/629),灵敏度为46.0%,特异度为95.5%;MCE对心肌缺血患者冠状动脉狭窄的诊断正确率为90.6%(570/629),灵敏度为78.6%,特异度为98.7%。MCE对心肌缺血患者冠状动脉狭窄的诊断正确率高于TTE(P<0.05)。ROC曲线分析显示,TTE诊断心肌缺血患者冠状动脉狭窄的AUC为0.708,MCE为0.886。TTE对心肌缺血患者冠状动脉重度狭窄的诊断正确率为88.1%(554/629),灵敏度为25.3%,特异度为98.2%;MCE对心肌缺血患者冠状动脉重度狭窄的诊断正确率为91.6%(576/629),灵敏度为41.4%,特异度为99.6%。MCE对心肌缺血患者冠状动脉重度狭窄的诊断正确率高于TTE(P<0.05)。ROC曲线分析显示,TTE诊断心肌缺血患者冠状动脉重度狭窄的AUC为0.617,MCE为0.705。结论MCE对心肌缺血患者冠状动脉狭窄及重度狭窄的诊断价值优于TTE。Objective To compare the diagnostic value of myocardial contrast echocardiography(MCE)and transthoracic echocardiography(TTE)on coronary arteriostenosis in patients with myocardial ischemia.Methods A total of 37 patients with myocardial ischemia were selected from Cardiovascular Department of Shaanxi Provincial People's Hospital from January to June 2019.All patients were examined successively with TTE,MCE and CAG.The results of CAG examination were used as the"gold standard"for the diagnosis of coronary arteriostenosis in patients with myocardial ischemia,accuracy,sensitivity and specificity of TTE and MCE in the diagnosis of coronary arteriostenosis and severe coronary arterio stenosis in patients with myocardial ischemia were compared,and the AUC was calculated by ROC curve.Results In diagnosis of coronary arteriostenosis in patients with myocardial ischemia,the accuracy rate of TTE was 75.7%(476/629),the sensitivity was 46.0%,and the specificity was 95.5%.The accuracy rate of MCE in diagnosis of coronary arteriostenosis in patients with myocardial ischemia was 90.6%(570/629),sensitivity was 78.6%and specificity was 98.7%.The accuracy rate of MCE in diagnosis of coronary arteriostenosis in patients with myocardial ischemia was higher than that of TTE(P<0.05).ROC curve showed that,the area under curve(AUC)of TTE and MCE in diagnosis of coronary arteriostenosis in patients with myocardial ischemia was 0.708 and 0.886,respectively.In diagnosis of severe coronary arteriostenosis in patients with myocardial ischemia,the accuracy rate of TTE was 88.1%(554/629),the sensitivity was 25.3%,and the specificity was 98.2%.The accuracy,sensitivity and specificity of MCE were 91.6%(576/629),41.4%and 99.6%,respectively.The accuracy rate of MCE in diagnosis of severe coronary arteriostenosis in patients with myocardial ischemia was higher than that of TTE(P<0.05).The ROC curve showed that the AUC of MCE and TTE in diagnosis of severe coronary arteriostenosis in patients with myocardial ischemia was 0.617 and 0.705,respectively

关 键 词：心肌缺血 心肌声学造影 经胸超声心动图 冠状动脉血管造影术 心肌灌注 微循环 诊断 

分 类 号：R542.2[医药卫生—心血管疾病]