胸痛及伴随症状评分对非ST段抬高型急性冠脉综合征的诊断价值  

Diagnostic value of chest pain and concomitant symptom score in non-ST-segment elevation acute coronary syndrome

作　　者：刘会君[1] 卫世强[1] 段玉慧 赵会健 段鹏[2] LIU Hui-jun;WEI Shi-qiang;DUAN Yu-hui;ZHAO Hui-jian;DUAN Peng(Department of Cardiovascular Medicine,83rd Army Military Hospital,Xinxiang,Henan 453000,China;Department of Intervention,83rd Army Military Hospital,Xinxiang,Henan 453000,China)

机构地区：[1]中国人民解放军陆军第八十三集团军医院心血管内科,河南新乡453000 [2]中国人民解放军陆军第八十三集团军医院介入科,河南新乡453000

出　　处：《医药论坛杂志》2023年第15期52-54,59,共4页Journal of Medical Forum

摘　　要：目的 探讨胸痛及伴随症状评分系统对非ST段抬高型急性冠脉综合征患者的诊断价值。方法 通过制定纳入、排除标准,对2018年9月至2019年2月以非ST段抬高型急性冠脉综合征为第一诊断的连续病例进行筛选,同期筛选其他因胸痛入院而最终排除冠脉疾病的患者入组对照组,制定胸痛及伴随症状评分标准,依据标准对入组病例进行评价,并将两组资料进行对比,了解评分分布情况,根据评分绘制ROC曲线,计算曲线下面积、界值,根据界值进行四格表绘制,计算敏感度、特异度、约登指数、一致性检验,从而评价此评分体系的临床意义。结果 非ST段抬高型急性冠脉综合征患者为(1.82±3.09)分,中位得分3分,对照组为(-1±2.27)分,中位得分为-1分,秩和检验P=0.001;ROC曲线下面积为0.769,P=0.001,界值=2;以界值为2时,判断患者为NSTE-ACS的敏感度为66.7%,特异度为85.7%,约登指数为0.524,阳性预测值为82.8%,阴性预测值为71.4%,准确度为76.1%,一致性检验Kappa=0.522,P=0.001。结论 通过胸痛及伴随症状评分系统,可以帮助对因胸痛症状收治入院的患者进行初筛,尤其是对NSTE-ACS患者,缩短诊治时间,改善患者的预后,从而最终降低不良心血管事件的发生。Objective To investigate the diagnostic value of chest pain and accompanying symptoms scoring system in patients with non-ST-segment elevation acute coronary syndrome.Methods By setting into and exclusion criteria,from September 2018 to February 2019 in non St-elevation acute coronary syndrome for the first diagnosis of consecutive cases of screening,screening other chest pain in the same period and eventually eliminate coronary artery disease pa-tients in control group,symptoms develop chest pain and with scoring criteria,according to the standard to evaluate into groups of cases,the ROC curve was drawn according to the score,the area under the curve and the cut-off value were calculated.The four-grid table was drawn according to the cut-off value,and the sensitivity,specificity,Youden in-dex and consistency test were calculated,so as to evaluate the clinical significance of the scoring system.Results The median score of non-ST segment elevation acute coronary syndrome was 3(1.82±3.09)in patients,and(-1±2.27)in control group(P=0.001).The area under the R0C curve was 0.769,P=0.001,cut-off value=2;When the cut-off value was 2,the sensitivity,specificity,Youden index,positive predictive value,negative predictive value and accuracy of NSTE-ACS were 66.7%,85.7%,0.524,82.8%,71.4%,76.1%,and Kappa=0.522,P=0.001,respectively.Conclusion The chest pain and accompanying symptoms scoring system can help us to screen pa-tients with chest pain symptoms,especially NSTE-ACS patients,shorten the diagnosis and treatment time,improve the prognosis of patients,and ultimately reduce the incidence of adverse cardiovascular events.

关 键 词：非ST段抬高型急性冠脉综合征 冠状动脉造影检查 高敏感肌钙蛋白T 受试者工作特征曲线 界值 四格表 

分 类 号：R541.4[医药卫生—心血管疾病]