平板运动试验及心肌灌注显像在飞行人员不典型心肌缺血诊断中的对比研究

Clinical evaluation of treadmill exercise test electrocardiography in detection of myocardial ischemia in pilots with untypical chest pain as comparison with myocardial perfusion imaging

目的评价活动平板运动试验对飞行人员不典型心肌缺血的诊断价值,并和心肌灌注显像及冠状动脉造影作对比研究,为其医学鉴定提供参考依据。方法不典型胸痛患者38例,均行活动平板运动试验及心肌灌注显像,结果分别与冠状动脉造影相比较。结果38例冠状动脉造影检查中有13例冠状动脉狭窄病变;运动试验阳性15例,阴性23例;心肌灌注显像检出可逆性心肌缺血16例,阴性22例。运动试验、心肌灌注显像诊断冠心病心肌缺血的灵敏度、特异性、准确性分别为53.8%、68.0%、63.2%和92.3%、84.0%、86.8%。结论活动平板运动试验出现异常ST-T改变,对诊断不典型胸痛患者冠心病心肌缺血有一定的意义,对飞行人员群体的冠心病诊断和排除亦有一定的应用价值。心肌灌注显像在飞行人员体检中的应用价值高于平板运动试验。

Objective To evaluate the value of treadmill exercise test electrocardiography in detection of myocardial ischemia in pilots with untypical chest pain and compared with ^99mTc-MIBI myocardial perfusion imaging and coronary angiography（CAG）. Methods Treadmill exercise test and ^99mTc-MIBI myocar- dial perfusion imaging were performed in 38 pilots with untypical chest pain. Final results were confirmed by CAG. Results Thirteen out of 38 patients had significant coronary stenosis; 15 patients were positive in treadmill exercise test, 7 patients were true positive, 8 patients were false positive; 23 patients were nega- tive, 17 patients were true negative. The sensitivity, specificity and accuracy were 53. 8%, 68. 0% and 63. 2 % respectively. Sixteen showed reversible perfusion abnormalities in ^99mTc-MIBI myocardial perfusion imaging, 12 were true positive, 4 were false positive, 1 was false negative, 21 were true negative. The sensitivity, specificity and accuracy of myocardial perfusion imaging for coronary disease detection were 92.3 %, 84. 0% and 86.8% respectively. Conclusions Treadmill exercise test is valuable in detection of myocardial ischemia in pilots with untypical chest pain. However, as a result of relative low sensitivity and specificity, further examination is needed. Myocardial perfusion imaging were the key point for diagnosis of myocardial ischemia in patients with untypical chest pain.