全科医学理念指导下的无创冠心病诊断方法LVDd联合SDNN新探索  

A new exploration of non-invasive coronary heart disease diagnosis method under the guidance of general medicine concept:LVDd combined with SDNN

作　　者：余彬 袁明清 罗潇 曹俊达[1] 徐劲松 李菊香[2] YU Bin;YUAN Ming-Qing;LUO Xiao(Internal Medicine-Cardiovascular Department,Jiujiang NO.1 People’s Hospital,JiuJiang 332000,Jiangxi,China)

机构地区：[1]九江市第一人民医院心血管内科,江西九江332000 [2]南昌大学第二附属医院心血管内科

出　　处：《吉林医学》2024年第11期2638-2642,共5页Jilin Medical Journal

基　　金：2022年江西省卫生健康委员会科技计划项目[项目编号:202211860];2021年九江市科技局重点研发计划项目[项目编号:JJSKJJ-2021-ZDYF-14]。

摘　　要：目的:探索左室舒张末径(LVDd)联合正常RR间期的标准差(SDNN)作为无创预测方案用于冠心病的诊断价值,为基层医疗单位进行无创冠心病的诊断筛查提供新思路。方法:选取2020~2022年在九江市第一人民医院和南昌大学第二附属医院就诊并进行冠脉造影检查明确冠心病诊断且完善动态心电图检查的323例患者作为研究对象,比较冠心病组与非冠心病组包括病史、血液学检查、彩超检查、动态心电图检查等相关参数在内的一般资料情况。设置是否罹患冠心病作为目标观察事件,对比分析各项参数是否为冠心病诊断的影响因素;进而就相关影响因素的疾病诊断预测价值进行分析。结果:二元Logistic回归分析显示年龄、LVDd、SDNN是冠心病诊断结果的影响因素。LVDd评价冠心病诊断结果的受试者工作特征(ROC)曲线下的面积(AUC)为0.581(95%CI=0.520~0.643),最佳截断值为51.25,灵敏度为0.332,特异度为0.850;SDNN评价冠心病诊断结果的ROC曲线下AUC为0.740(95%CI=0.684~0.795),最佳截断值为100.5,灵敏度为0.821,特异度为0.609;LVDd联合SDNN评价冠心病诊断结果的ROC曲线下AUC为0.762(95%CI=0.708~0.815),最佳截断值为0.459,灵敏度为0.853,特异度为0.541。结论:LVDd联合SDNN对于冠心病的预测诊断价值良好。Objective To explore the value of Left ventricular diastolic diameter(LVDd)combined with standard deviation of normal RR interval(NN standard deviation,SDNN)as a noninvasive prediction scheme for the diagnosis of coronary heart disease.For the primary care unit for noninvasive diagnosis of coronary heart disease screening provides new train of thought.Method 323 patients who visited the First People's Hospital of Jiujiang City and the Second Affiliated Hospital of Nanchang University from 2020 to 2022 and underwent coronary angiography to confirm the diagnosis of coronary heart disease and complete dynamic electrocardiogram examination were selected as the research subjects.The general data including medical history,hematological examination,color Doppler ultrasound examination,dynamic electrocardiogram examination and other related parameters were compared between the coronary heart disease group and the non-coronary heart disease group.Coronary heart disease was set as the target observation event,and the influencing factors of coronary heart disease diagnosis were compared and analyzed.The predictive value of related factors was analyzed.Results Binary Logistic regression analysis showed that age,LVDd and SDNN were the influencing factors of the diagnosis of CHD.The area under the ROC curve(AUC)of LVDd was 0.581(95%CI=0.520~0.643),the best cut-off value was 51.25,the sensitivity was 0.332,and the specificity was 0.850.The area under the ROC curve(AUC)of SDNN was 0.740(95%CI=0.684~0.795),the best cut-off value was 100.5,the sensitivity was 0.821,and the specificity was 0.609.The area under the ROC curve(AUC)of LVDd combined with SDNN for the diagnosis of CHD was 0.762(95%CI=0.708~0.815),the best cut-off value was 0.459,the sensitivity was 0.853,and the specificity was 0.541.Conclusion LVDd combined with SDNN has a good predictive value for CHD.

关 键 词：左室舒张末径 正常RR间期的标准差 冠心病 预测价值 无创诊断方法 

分 类 号：R541.4[医药卫生—心血管疾病]