心绞痛三组症状对不同性别冠心病患者的诊断意义

Clinical Characteristics and Analysis for Diagnosing Coronary Artery Disease of Angina Symptoms Complex in Differeut Sex

目的:分析女性冠心病患者心绞痛的临床特点,评估使用心绞痛三组症状诊断冠心病的敏感性和特异性。方法:研究对象为1998年7月1日至2005年6月30日在北京协和医院东院住院并进行冠状动脉造影的患者4503例,女性1557例,男性2946例。心绞痛三组症状包括①胸骨后的不适感,其性质和持续时间均有特征性,即心绞痛时间性质部位符合;②劳力或情绪激动可诱发心绞痛症状;③休息或硝酸甘油可缓解心绞痛症状。冠心病的诊断以冠状动脉造影一支或一支以上的冠状动脉直径狭窄≥50%为标准。结果:女性患者中,可以进行心绞痛症状分析的病例1283例,平均年龄为(63.0±9.1)岁,仅表现为一组心绞痛症状者195例,同时表现为二组或三组症状者分别为461例和570例,无心绞痛症状者57例。755例女性冠心病患者,休息或硝酸甘油可缓解708例,劳力或情绪激动可诱发534例,心绞痛时间性质部位符合544例,738例符合心绞痛三组症状的任何一组表现,使用心绞痛一组症状对于女性患者冠心病诊断的敏感性分别为93.77%、70.73%、72.05%和97.75%,特异性分别为12.48%、41.78%、47.45%和7.56%。755例女性冠心病患者中,520例同时符合心绞痛劳力或情绪激动可诱发和休息或硝酸甘油可缓解,402例心绞痛时间性质部位符合和劳力或情绪激动可诱发,515例心绞痛时间性质部位符合和休息或硝酸甘油可缓解,658例符合心绞痛三组症状的任何二组表现,同时具备心绞痛二组症状的组合,对于女性患者冠心病诊断的敏感性分别为68.87%、53.25%、68.21%和87.15%,特异性分别为46.12%、64.46%、50.85%和29.49%。755例女性冠心病患者中有390例同时表现出心绞痛的三组症状,其对冠心病诊断的敏感性和特异性分别为51.66%和65.91%。结论:女性患者的心绞痛症状有一定的特点,三组症状的不同组合对于冠心病诊断有不同的临床意义。

Objective：To investigate the characteristics of angina symptom complex of patients with coronary artery disease （CAD） and to analyze their sensitivity and specificity of angina symptom complex in the diagnosis of CAD. Methods.4 503 in-hospital patients （ 1 557 women, 2 946 men） received coronary angiography during July 1, 1998 to June 30, 2005. Those who had more than 50% stenosis of coronary artery by angiography were diagnosed as having CAD. Angina symp- tom complex can be classified into 3 groups ： （1）substernal chest discomfort with a characteristic nature and duration, （2）provoked by exertion or emotional stress, and （3）relieved by rest or nitroglycerin. Results：In 1 283 women （63. 0 ±9. 1 years） who had detailed records, 195 fell into 1 group, 461 fell into 2 groups, 570 had characteristics of 3 groups, and 57 had no angina symptom complex. In 755 women with CAD, 708 had angina symptom relieved by rest or nitroglycerin, 534 had angina symptom provoked by exertion or emotional stress, 544 had substernal chest discomfort with a characteristic nature and duration, and 738 had manifestations of any one of the 3 groups. The diagnostic sensitivity by 1 group was 93.77%, 70. 73%, 72.05% and 97.75%, and the specificity was 12.48% , 41.78% , 47.45% and 7. 56% . 520 women with CAD had angina symptom provoked by exertion or emotional stress and relieved by rest or nitroglycerin. 402 had substernal chest discomfort with a characteristic nature and duration and their aug/ha was provoked by exertion or emotional stress. 515 had substernal chest discomfort with a characteristic nature and duration and their angina was relieved by rest or nitroglycerin. 658 patients had manifestations of any two of the 3 groups, the with the sensitivity of 68. 87%, 53.25 %, 68.21% and 87.15% , and the specificity of 46. 12% , 64.46% , 50. 85% and 29.49% . 390 women with CAD had symptoms of three groups, and the sensitivity and specificity was 51.66% and 65.91%. Conclusion ：The women CAD patients have their own characteristics of angina symptom complex. Different combination of the three angina symptom complex groups has different clinical significance in CAD diaguosis.