动态心电图各指标单独及联合应用对冠心病诊断价值的对比

Comparing of the diagnostic value about coronary heart disease by single or combined variables of ambulatory electrocardiograph

目的探讨动态心电图指标单独及联合应用时对冠心病的诊断价值。方法选择126例同期行冠状动脉造影(CAG)和24h动态心电图(AECG)监测的病人,按CAG结果分组,对比分析AECG所获得的指标对各组冠心病人的诊断价值。结果①ST、ST/HR、SDNN对冠脉病变诊断的灵敏度、特异度、阳性预测值、阴性预测值、约登指数分别为:79.12%,62.86%,84.71%,53.66%,0.42;78.02%,94.29%,97.26%,62.26%,0.72;71.43%,82.86%,92.86%,52.73%,0.54;以ST/HR诊断价值最大;②单支、双支、三支冠脉病变组比较,各指标对冠脉病变诊断的敏感性均依次递增(ST:45.16% vs 93.33% vs 100.00%,p<0.01;ST/HR:54.84% vs 90.00% vs 90.00%,p<0.01;SDNN:38.7% vs 76.67% vs 100.00%,p<0.01),差异均有显著性;③ST/HR与SDNN并联时对冠脉病变诊断的灵敏度、特异度、阳性预测值、阴性预测值、约登指数分别为:92.31%,80.00%,92.31%,80.00%,0.72;其灵敏度、特异度均≥80%,效果最佳。结论①ST、ST/HR、SDNN指标是诊断冠脉病变严重程度的较好指标,其中以ST/HR的诊断价值最大;②ST/HR与SDNN联合运用可提高AECG对冠心病的诊断价值;③冠状动脉病变范围越广、程度越重,AECG对冠心病的诊断敏感性越高。

Objective To study the diagnostic value about coronary heart disease （CHD） by AECG. Methods We selected 126 patients who had undergone 24h AECG and selective coronary angiography （CAG） in the same period. The groups were divided according to the results of CAG.Then we analyzed and compared with the diagnostic value to every group of CHD by variables of ST and HRV which accepted by AECG. Results（1）The sensitivity, specificity, positive predictive value, negative predictive value and youden＇s index of ST, ST/HR and SDNN to diagnosis CHD,were as follow respectively： 79.12%, 62.86%, 84.71%, 53.66% ,0.42 ;78.02%, 94.29%, 97.26%, 62.26% ,0.72 ; 71.43%, 82.86% ,92.86% ,52.73% ,0.54. （2） Compared with the three groups of single, double and triplet, the sensitivity to the diagnosis of CHD by each variable was increasing （ST：45.16% vs 93.33% vs 100.00%, p 〈0.01;ST/HR：54.84% vs 90.00% vs 90.00%,p〈0.01;SDNN：38.7% vs 76.67% vs 100.00%, p 〈0.01）. （3）When we parallel connection of ST/HR and SDNN , the sensitivity, specificity, positive predictive value, negative predictive value and youden＇s index were as follow ： 92.31% ,80.00% ,92.31% , 80.00% ,0.72;The sensitivity and specificity were all 〉t80%. Conclusions （1） ST, ST/HR and SDNN were the reliable variables of reflecting myocardial ischemia and the extend of coronary pathology.. （2）Using the method of parralled connection by ST/HR and SDNN could improve the diagnostic value to CHD. （3）The more extensive of coronary pathology, the better diagnostic value about CHD by AECG.