电子束计算机断层摄影术检出冠状动脉钙化诊断冠心病的再评价

Re evaluation of the Electron beam Computed Tomography in Diagnosis of Coronary Artery Disease

目的：评价电子束计算机断层摄影术（ＥＢＣＴ）平扫诊断冠心病的价值。方法：５６８例进行冠状动脉造影的患者，于冠状动脉造影前进行冠状动脉ＥＢＣＴ检查。采用心电触发单层序列平扫。以冠状动脉造影存在１支以上的管径狭窄≥５０％为诊断冠心病标准。结果：５６８例患者中，冠心病患者３７６例，无冠心病患者１９２例。冠心病患者的冠状动脉钙化计分（２８３．８５±５６３．６３）明显高于非冠心病患者（３３．４６±９２．１１，Ｐ＜０．００１）。以ＥＢＣＴ有无冠状动脉钙化判断冠心病的敏感性、特异性及准确性分别为８２．９８％、６６．６７％及７７．４６％。在５０岁以下（不含５０岁，５０岁以下组）的患者，冠状动脉钙化判断冠心病的特异性和阳性预测值较５０岁以上（５０岁以上组）患者高，但敏感性较低；５０岁以下组的患者，左回旋支及右冠状动脉钙化预测冠心病的价值高于前降支钙化。结论：ＥＢＣＴ发现的冠状动脉钙化对冠心病诊断有重要意义，尤其对５０岁以下组的患者。

Objective:To evaluate the value of electron beam computed tomography (EBCT) in the diagnosis of coronary artery disease(CAD). Methods:Five hundred and sixty eight patients underwent coronary angiography and EBCT.An Imatron C 150 EBCT scanner with ECG triggered single slice mode scanning program was used.Coronary artery disease was defined as a stenosis of coronary artery of more than 50% in diameter in at least one branch. Results:Of the 568 individuals,376 were with CAD and 192 without CAD.The coronary calcification score was much higher in patients with CAD (283.85±563.63) compared with those without CAD (33.46±92.11), p <0.001.The sensitivity,specificity,and accuracy for existed coronary calcification to predict CAD were 82.98%,66.67% and 77 46%,respectively.The predictive value of coronary calcification for CAD was higher in patients younger than 50 years than those of elder than or equal to 50 years.For patients younger than 50 years,the predictive value of coronary calcification in left circumflex artery and right coronary artery was higher than that in left anterior descending artery. Conclusion:Coronary calcification by EBCT is helpful in the prediction of coronary artery disease with an accepted accuracy,especially in younger patients.