桡动脉激发试验对冠状动脉痉挛诊断价值的探讨  

Study on the diagnostic value of radial artery stimulation test in coronary artery spasm

作　　者：黎叶飞[1] 张青 张波 盛臻强[1] LI Yefei;ZHANG Qing;ZHANG Bo;SHENG Zhenqiang(Department of Cardiology,the Second Affiliated Hospital of Nantong University,Nantong 226001)

机构地区：[1]南通大学第二附属医院心内科,南通226001

出　　处：《南通大学学报（医学版）》2021年第4期330-334,共5页Journal of Nantong University(Medical sciences)

基　　金：南通市科技局民生科技计划项目(MS219183);南通市卫生健康委员会面上项目(MB201913)。

摘　　要：目的:探讨桡动脉激发试验诊断冠状动脉痉挛(coronary artery spasm,CAS)的敏感性和特异性以及安全性。方法:收集冠状动脉主要分支及桡动脉狭窄<50%胸痛患者,根据冠状动脉麦角新碱激发试验结果,分为CAS组24例、对照组33例,依次进行桡动脉乙酰胆碱、麦角新碱激发试验。结果:200μg乙酰胆碱未诱发桡动脉狭窄,400、800μg乙酰胆碱桡动脉狭窄程度两组差异均无统计学意义(均P>0.05)。CAS组60、100、160μg麦角新碱诱发桡动脉狭窄程度均高于对照组(均P<0.05);CAS组100、160μg麦角新碱诱发桡动脉狭窄高于60μg(均P<0.05),100、160μg之间差异无统计学意义(P>0.05);对照组100、160μg麦角新碱诱发桡动脉狭窄高于60μg(均P<0.05),160μg高于100μg(P<0.05)。60μg麦角新碱桡动脉激发试验诊断CAS的受试者工作特征曲线(receiver operator characteristic curve,ROC)曲线下面积0.721,特异性90.91%,敏感性50.0%;100μg麦角新碱ROC曲线下面积0.864,特异性96.97%,敏感性66.67%;160μg麦角新碱ROC曲线下面积0.944,特异性90.91%,敏感性95.83%。除160μg麦角新碱在CAS组诱发1例冠状动脉狭窄外,其余剂量乙酰胆碱和麦角新碱未诱发冠状动脉狭窄。结论:桡动脉乙酰胆碱激发试验对CAS无诊断价值,桡动脉麦角新碱激发试验诊断CAS敏感性、特异性较高,安全性与麦角新碱剂量有关。Objective:To investigate the sensitivity,specificity and safety of radial artery provocation test in the diagnosis of coronary artery spasm(CAS).Methods:The patients with chest pain as well as had coronary stenosis<50%and radial artery stenosis<50%,were enrolled in this study.The patients were divided into CAS group and control group after intracoronary acetylcholine provocation test.Radial acetylcholine and ergonovine provocation test were performed successively.Results:In the radial artery provocation test at 200μg of acetylcholine,no radial artery stenosis occurred,and there was no difference in the degree of radial artery stenosis between 400μg and 800μg of acetylcholine groups(P>0.05).The degree of radial artery stenosis induced by 60μg,100μg and 160μg ergonovine in CAS group was higher than that in control group(P<0.05).In CAS group,the radial artery stenosis induced by 100μg and 160μg ergonovine was higher than 60μg(P<0.05),and there was no difference between 100μg and 160μg(P>0.05).In the control group,the radial artery stenosis induced by 100μg and 160μg ergonovine was higher than 60μg(P<0.05),and 160μg was higher than 100μg(P<0.05).The area under the receiver operator characteristic curve(ROC)was 0.721,the specificity was 90.91%,and the sensitivity was 50.00%.The area under ROC curve of 100μg ergonovine 0.864,the specificity was 96.97%and the sensitivity was 66.67%.The area under ROC curve of 160μg ergonovine was 0.944,the specificity was 90.91%and the sensitivity was 95.83%.Except for one case of coronary artery stenosis induced by 160μg ergonovine in CAS group,the other doses of acetylcholine and ergonovine did not induce coronary artery stenosis.Conclusion:Radial artery acetylcholine provocation test has no diagnostic value for CAS.Radial artery ergonovine provocation test has high sensitivity and specificity in the diagnosis of CAS,and its safety is related to ergonovine dose.

关 键 词：冠状动脉痉挛 桡动脉 麦角新碱 乙酰胆碱 激发试验 

分 类 号：R543.3[医药卫生—心血管疾病]