运动试验后收缩压异常升高对冠心病诊断价值的初步探讨  

Preliminary study of abnormal increase of post-exercise systolic blood pressure in the diagnosis of coronary artery disease

作　　者：于宗良[1] 杨向军[1] 高美雯[1] 王国强[1] 李勋[1] 惠杰[1] 蒋廷波[1] 宋建平[1] 刘志华[1] 蒋文平[1] 

机构地区：[1]苏州大学附属第一医院心内科,215006

出　　处：《中华心血管病杂志》2004年第3期233-236,共4页Chinese Journal of Cardiology

摘　　要：目的　评价运动试验恢复期收缩压异常升高对冠心病的诊断价值 ,以及高血压对其诊断准确性的影响。方法　观察了 80例先后行平板运动试验和冠状动脉造影的患者 ,根据高血压病的有无和冠状动脉造影结果分组 ,以运动试验后 6min内 ,收缩压后期比前期升高≥ 10mmHg(1mmHg =0 133kPa)为收缩压异常升高为阳性判定标准。结果　收缩压异常升高诊断冠心病的敏感性、特异性、准确性、阳性预测值和阳性似然比 ,高于ST段压低标准 ;其敏感性与冠状动脉病变程度成正比 ;对合并高血压的患者 ,两指标 (收缩压异常升高和ST段压低 )联用可显著提高诊断的特异性和阳性预测值。Objective This study sought to evaluate the diagnostic value of abnormal increase of post exercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing was conducted in 23 patients with normal blood pressure and 57 patients with hypertension, each of whom underwent selective coronary angiography. Forty six patients had significant narrowing of coronary artery (patients with CAD), the other 34 patients with normal coronary angiography were used as control subjects. The abnormal increase of post exercise SBP was defined as an increase of ≥10 mm Hg than earlier periods during the recovery phase (6 minutes) of exercise testing. Results Abnormal increase of post exercise SBP had higher sensitivity, specificity, accuracy, positive predictive value, and positive likelihood ratio than those of ST segment depression for detecting CAD in patients with or without hypertension. The accuracy increased with the severity of coronary artery lesion. The combination of ST segment depression and abnormal increase of SBP diagnosed CAD most accurately in patients with hypertension. The diagnostic values were 81%, 90%( P <0 01vs ST segment), 84%, 94%( P <0 05vs ST segment) and 8 47, respectively. Conclusion Abnormal increase in post exercise SBP may be a useful index for diagnosing CAD.

关 键 词：运动试验 收缩压异常升高 冠心病 诊断 

分 类 号：R541.4[医药卫生—心血管疾病]