第二代定量血流分数诊断冠状动脉功能性狭窄准确度的研究  

Accuracy of Second Generation Quantitative Flow Ratio in Diagnosing Coronary Stenosis

作　　者：孙明明 黄育铭 贾乾君[1] 杨峻青 吴全敏 陈联胜 谈文开 费洪文 黄美萍[1] SUN Mingming;HUANG Yuming;JIA Qianjun;YANG Junqing;WU Quanmin;CHEN Liansheng;TAN Wenkai;FEI Hongwen;HUANG Meiping(Cardiac Catheter Room,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Science),Southen Medical University,Guangzhou 510080,China;Department of Cardiology,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Science),Southen Medical University,Guangzhou 510080,China;Department of Cardiovascular Auxiliary Diagnosis,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Science),Southen Medical University,Guangzhou 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)心导管室,广州510080 [2]南方医科大学附属广东省人民医院(广东省医学科学院)心内科,广州510080 [3]南方医科大学附属广东省人民医院(广东省医学科学院)心血管辅助诊断科,广州510080

出　　处：《岭南心血管病杂志》2023年第1期19-25,共7页South China Journal of Cardiovascular Diseases

基　　金：广东省基础与应用基础研究项目(项目编号:2022A1515010157)。

摘　　要：目的 探讨第二代定向血流分数(quantitative flow ratio,QFR2)诊断冠状动脉功能性狭窄的准确度。方法 回顾性纳入2017年1月至2018年3月在广东省人民医院因怀疑冠状动脉粥样硬化性心脏病(冠心病)而进行冠状动脉造影检查及血流储备分数(fractional flow reserve,FFR)检查的患者资料,分析血管的QFR2与定量冠状动脉造影(quantitative coronary angiography,QCA)的数值。采用Spearman相关性计算QFR2与FFR的相关性。以FFR为“金标准”,计算QFR2与QCA的诊断准确度、敏感度、特异度、阳性预测值、阴性预测值。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)并计算曲线下面积(area under curve,AUC),探讨QFR2在冠状动脉功能性狭窄方面的临床诊断价值。结果 本研究共入选163例患者(178条血管),以FFR的数据为“金标准”,QFR2诊断冠状动脉功能性狭窄的准确度明显高于QCA(95.51%vs. 61.24%,P<0.01),QFR2的敏感度和特异度均高于QCA(敏感度:85.45%vs. 50.91%,P<0.01,特异度:100.00%vs. 65.85%,P<0.01)。QFR2的阳性预测值,阴性预测值分别为100.00%,93.89%。QFR2诊断能效明显优于QCA(AUC:0.96vs. 0.66,P<0.01)。QFR2与FFR之间的相关系数是0.71(P<0.01)。结论 QFR2诊断冠状动脉功能性狭窄的准确度高,在冠状动脉的血流动力学方面具有临床诊断应用价值。Objectives To investigate the accuracy of second generation quantitative flow ratio(QFR2)in diagnosing coronary stenosis.Methods Clinical data of patients who had undergone coronary angiography and fractional flow reserve(FFR)for suspected coronary artery disease from January 2017 to March 2018 in Guangdong Provincial People′s Hospital were enrolled in this retrospective study,and the values of QFR2 and quantitative coronary angiography(QCA)were analyzed respectively.Spearman correlation was used to calculate the correlation between QFR2 and FFR.Taking FFR as the golden standard,the diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value of QFR2 and QCA were calculated.Receiver operating characteristic curve(ROC)was drawn and the area under the curve(AUC)was calculated to explore the clinical diagnostic value of QFR2 in coronary stenosis.Results Totally 163 patients(178 vessels)were enrolled in this study.Taking the FFR as the golden standard,the accuracy of QFR2 in diagnosing coronary stenosis was significantly higher than that of QCA(95.51%vs.61.24%,P<0.01),and the sensitivity and specificity of QFR2 were higher than that of QCA(sensitivity:85.45%vs.50.91%,P<0.01;specificity:100.00%vs.65.85%,P<0.01).The positive predictive value and negative predictive value of QFR2 were 100.00%and 93.89%,respectively.The AUC of QFR2 was significantly better than that of QCA(0.96 vs.0.66,P<0.01).The Spearman correlation coefficient between QFR2 and FFR was 0.71(P<0.01).Conclusions QFR2 has high accuracy in the diagnosis of coronary stenosis and has clinical value in diagnosing the coronary hemodynamics.

关 键 词：冠状动脉功能学 定量血流分数 血流储备分数 定量冠状动脉造影 

分 类 号：R54[医药卫生—心血管疾病]