螺旋CT冠状动脉显像联合运动平板试验对冠心病诊断的评价.DOCVIP

临床医学论文-螺旋CT冠状动脉显像联合运动平板试验对冠心病诊断的评价 【摘要】? 目的：评价16排螺旋CT冠状动脉显像（冠状动脉CTA）联合运动平板试验（TET）对冠心病的诊断价值。方法：分析10个月来在我院行冠状动脉造影（CAG）的资料完整的病例165例。其中术前行冠状动脉CTA检查57例；行TET检查76例；二者联合检查32例。结果：冠状动脉CTA组敏感性94%，特异性58%，阳性预测值72%。TET组敏感性56%，特异性78%，阳性预测值63%。联合检查组敏感性95%，特异性85%，阳性预测值90%。结论：冠状动脉CTA联合运动平板试验可显著提高疑似冠心病检出率。 【关键词】? 冠心病 螺旋CT 运动平板试验 冠状动脉造影 　　The Value of Spiral CT Coronary Arteriography Combined with Treadmill Exercise Testing in Diagnosis of Coronary Heart Disease 　　Li Liqiang；Zhang Ruihong；Wu Huimin 　　The First People’s Hospital of Xuzhou, Xuzhou, Jiangsu 221002, China ??? Abstract:Objective To assess the value of 16slice spiral CT coronary arteriography(coronary CTA) combined with treadmill exercise testing(TET) in diagnosing coronary heart disease(CHD).Methods 165 suspected CHD patients with clinical presentation perfectly collected were summarized in about 10 months recently.Every patient was examined by coronary angiography(CAG).Spiral CT scanning were performed in 57 cases;76 cases were examined by TET,and 32 cases were received both examination before operation. Results In coronary CTA group,the sensitivity,specificity and positive predictive values was 94%,58%,72%,in TET group?was 56%,78%,63%,while in combination group was 95%,85%,90%. Conclusion Cronary CTA combined TET can significantly improve the identifying rate of suspected CHD. ??? Key word： Coronary heart disease; Spiral CT; Treadmill exercise testing; Coronary angiography ??? 选择性经皮冠状动脉造影术（CAG）无疑是诊断冠心病的金标准，但风险大，费用昂贵，设备技术要求高，许多患者不愿接受。运动平板试验（TET）已广泛应用于临床，但准确性受人置疑［1］。螺旋CT冠状动脉显像（冠状动脉CTA）是近几年新兴的技术，心血管医师和放射科医师对此报道多不一致［2，3］。冠状动脉CTA联合TET检查对冠心病诊断的评价国内少有报道。本文以冠状动脉造影为标准，对此进行讨论。 　　1? 资料与方法 　　1.1? 研究对象? 　　回顾10个月来在我院行冠状动脉造影的病例165例。其中；男74例，女91例，年龄35岁～69岁。患者有心前区不适、心悸症状，可伴有高血压、高血脂、糖尿病、吸烟等危险因素。平静心电图正常或可疑心肌缺血或有期前收缩。所有病例均经冠状动脉造影检查。其中术前行冠状动脉CTA检查者57例，TET检查者76例，冠状动脉CTA联合TET检查者32例（在联合检查中冠状动脉CTA与TET矛盾者不记入统计数据，在讨论中另述）。 　　1.2? 方法? 　　冠状动脉造影由心血管医师执行，仪器为GE公司大型C臂X光机，股动脉穿刺,?? Judkins法，至少4个体位采集图象。冠状动脉CTA使用GE公司lightspeed Pro 16层螺旋CT进行扫描，先行胸部平扫，再以肘