静息心电图、胸痛症状与冠脉CTA筛查冠心病的临床价值(1)
摘 要：目的 探讨静息心电图、胸痛症状与256层螺旋CT冠脉成像筛查冠心病的诊断价值。方法 收集入院后接受静息心电图、256层螺旋CTA检查共计68例非急症胸痛疑似冠心病患者的相关资料，所有患者30 d内均进行CAG检查。以CAG诊断为标准，采用ROC曲线分析静息心电图、胸痛症状与冠脉CTA筛查冠心病的诊断价值。结果 256层螺旋CTA诊断冠心病的ROC曲线下面积为0.73(P<0.05)，其诊断敏感性为96.55%，特异性为50.00%，诊断价值大于静息心电图(AUC=0.50，P>0.05)和胸痛症状(AUC=0.51，P>0.05)。结论 256层螺旋CTA筛查冠心病有较高的诊断价值；静息心电图、胸痛症状对冠心病的筛查存在明显的局限性。
关键词：冠状动脉疾病；体层摄影术；X线计算机；血管造影术；冠状动脉粥样硬化斑块
中图分类号：R541.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.15.046
, http://www.100md.com
文章编号：1006-1959(2018)15-0143-03
Clinical Value of Resting Electrocardiogram，Chest Pain Symptoms and Coronary CTA Screening for Coronary Heart Disease
LI-Ning，HAN Li-ying，WANG Jun-wei，ZHAO Xiu-feng，CHANG Chao，LIU Li-jun，XIN Shuan-li
(Department of Cardiology，the First Hospital of Handan City，Handan 056000，Hebei，China)
Abstract：Objective To investigate the diagnostic value of resting electrocardiogram， chest pain and 256-slice spiral CT coronary angiography for coronary heart disease.Methods A total of 68 patients with suspected coronary heart disease and non-emergency chest pain were examined by resting electrocardiogram and 256-slice spiral CTA.All patients were examined with CAG within 30 d.The diagnostic value of resting electrocardiogram，chest pain symptom and coronary artery CTA screening for coronary heart disease was analyzed by ROC curve based on CAG diagnosis.Results The area under the ROC curve of 256-slice spiral CTA in the diagnosis of coronary heart disease was 0.73(P<0.05).The diagnostic sensitivity was 96.55%，the specificity was 50.00%.The diagnostic value was greater than that of resting electrocardiogram(AUC=0.50，P>0.05) and chest pain(AUC=0.51，P>0.05).Conclusion 256-slice spiral CTA has a high diagnostic value for coronary heart disease，and resting electrocardiogram and chest pain symptoms have obvious limitations in the screening of coronary heart disease.
, 百拇医药
Key words：Coronary artery disease；Tomography；X-ray computer；Angiography；Coronary atherosclerotic plaque
心電图是诊断冠心病(Coronary Heart Disease，CHD)的一种重要检查方法，因其高效，迅速，即时，是临床上不可替代的检测手段。近些年，随着冠状动脉造影技术的广泛开展，发现静息心电图是否表现为“心肌的缺血性改变”和冠脉的狭窄程度并无必然联系。但广大基层医师仍仅依据一份心电图诊断冠心病的情况比较常见。胸痛是冠心病的常见症状，真实世界中，较多非急症胸痛及不典型胸痛患者进行临床综合评估困难，易造成慢性心肌缺血患者的误诊漏诊。多层螺旋CT血管成像(computed tomogaphy angiography， CTA)诊断冠心病的技术日趋成熟，不仅可定性诊断冠心病，还可以无创性对冠脉狭窄程度作量化判断[1]。本研究探讨静息心电图，胸痛症状及冠脉CTA筛查冠心病的临床价值，进一步分析静息心电图筛查冠心病的局限性和冠脉CTA筛查冠心病的优势。
1资料与方法
1.1一般资料 回顾性收集华北理工大学附属医院2012年12月～2014年3月共计996例进行了选择性冠脉造影术(coronary angiography， CAG)检查。纳入标准：非急症胸痛疑似冠心病病例，在30 d内同时接受了CTA与CAG检查患者，患者入院时即刻进行了静息心电图检查。按照纳入标准共计72例病例入选。排除标准：临床诊断急性心肌梗死的患者、冠状动脉支架术后、冠状动脉搭桥术后，同时接受CTA与CAG检查的时间>30 d、CTA与CAG检查的间隔时间段内发生心肌梗死、CAG无法造影冠脉的全部血管支。最终纳入本研究共计68例患者。, 百拇医药(李宁 韩丽英 王俊伟 赵秀峰 常超 刘丽军 信栓力)
关键词：冠状动脉疾病；体层摄影术；X线计算机；血管造影术；冠状动脉粥样硬化斑块
中图分类号：R541.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.15.046
, http://www.100md.com
文章编号：1006-1959(2018)15-0143-03
Clinical Value of Resting Electrocardiogram，Chest Pain Symptoms and Coronary CTA Screening for Coronary Heart Disease
LI-Ning，HAN Li-ying，WANG Jun-wei，ZHAO Xiu-feng，CHANG Chao，LIU Li-jun，XIN Shuan-li
(Department of Cardiology，the First Hospital of Handan City，Handan 056000，Hebei，China)
Abstract：Objective To investigate the diagnostic value of resting electrocardiogram， chest pain and 256-slice spiral CT coronary angiography for coronary heart disease.Methods A total of 68 patients with suspected coronary heart disease and non-emergency chest pain were examined by resting electrocardiogram and 256-slice spiral CTA.All patients were examined with CAG within 30 d.The diagnostic value of resting electrocardiogram，chest pain symptom and coronary artery CTA screening for coronary heart disease was analyzed by ROC curve based on CAG diagnosis.Results The area under the ROC curve of 256-slice spiral CTA in the diagnosis of coronary heart disease was 0.73(P<0.05).The diagnostic sensitivity was 96.55%，the specificity was 50.00%.The diagnostic value was greater than that of resting electrocardiogram(AUC=0.50，P>0.05) and chest pain(AUC=0.51，P>0.05).Conclusion 256-slice spiral CTA has a high diagnostic value for coronary heart disease，and resting electrocardiogram and chest pain symptoms have obvious limitations in the screening of coronary heart disease.
, 百拇医药
Key words：Coronary artery disease；Tomography；X-ray computer；Angiography；Coronary atherosclerotic plaque
心電图是诊断冠心病(Coronary Heart Disease，CHD)的一种重要检查方法，因其高效，迅速，即时，是临床上不可替代的检测手段。近些年，随着冠状动脉造影技术的广泛开展，发现静息心电图是否表现为“心肌的缺血性改变”和冠脉的狭窄程度并无必然联系。但广大基层医师仍仅依据一份心电图诊断冠心病的情况比较常见。胸痛是冠心病的常见症状，真实世界中，较多非急症胸痛及不典型胸痛患者进行临床综合评估困难，易造成慢性心肌缺血患者的误诊漏诊。多层螺旋CT血管成像(computed tomogaphy angiography， CTA)诊断冠心病的技术日趋成熟，不仅可定性诊断冠心病，还可以无创性对冠脉狭窄程度作量化判断[1]。本研究探讨静息心电图，胸痛症状及冠脉CTA筛查冠心病的临床价值，进一步分析静息心电图筛查冠心病的局限性和冠脉CTA筛查冠心病的优势。
1资料与方法
1.1一般资料 回顾性收集华北理工大学附属医院2012年12月～2014年3月共计996例进行了选择性冠脉造影术(coronary angiography， CAG)检查。纳入标准：非急症胸痛疑似冠心病病例，在30 d内同时接受了CTA与CAG检查患者，患者入院时即刻进行了静息心电图检查。按照纳入标准共计72例病例入选。排除标准：临床诊断急性心肌梗死的患者、冠状动脉支架术后、冠状动脉搭桥术后，同时接受CTA与CAG检查的时间>30 d、CTA与CAG检查的间隔时间段内发生心肌梗死、CAG无法造影冠脉的全部血管支。最终纳入本研究共计68例患者。, 百拇医药(李宁 韩丽英 王俊伟 赵秀峰 常超 刘丽军 信栓力)