女性胸痛患者危险因素及无创检查的临床意义

The risk factors and clinical significance of non-invasive examinations of female chest pain

目的:分析女性胸痛患者危险因素及无创检查在冠心病诊断中的价值。方法:对我院2003年1月至2007年1月81例因胸痛入院行冠状动脉造影的女性患者的危险因素、无创检查及冠状动脉造影结果进行回顾性分析。结果:患者平均年龄(67.45±10.24)岁,确诊为冠心病50例,排除31例。50例冠心病患者中,单支病变20例(40%),2～3支病变30例(60%)。无创检查中常规心电图、运动试验、动态心电图、颈动脉超声、心脏超声的敏感性分别为44%、74%、58%、76%、40%,特异性分别为55%、65%、55%、52%、81%,准确性分别为48%、70%、58%、67%、56%。结论:无创检查方法中颈动脉超声敏感性最高,运动试验次之,特异性最好的是心脏超声,准确性最好的则是运动试验。女性冠心病多见于绝经后的中、老年人群,围绝经期人群中除非伴有糖尿病,通常发病率低,血管病变以多支血管病变为主。对并存高血压、糖尿病和高脂血症的胸痛患者即使无创检查未发现异常也应尽早行冠状动脉造影检查以明确诊断。

Objectives：Analyzed the risk factors and the value of non-invasive examinations in the diagnosis of cardiac heart disease. Methods： Retrospectively analyzed risk factors and the results of non-invasive examinations and coronary angiography in 81 female patients who admitted in our hospital from Jan,2003 to Jan,2007 with chest pain. Results：The average age of patients was 67.45±10.24. Total 50 cases were diagnosed as coronary heart disease and 31 cases were excluded. Among 50 cases of coronary heart disease,20 cases belonged to single-vessel disease（40%） and 30 cases belonged to 2-3 vessels disease（60%）. The sensitivity of non-invasive examinations such as regular EKG,treadmill,Holtor,ultrasound of carotid artery and heart is 44%,74%,58%,76% and 40%, respectively. Specificity of those are 55%,65%,55%,52% and 81% respectively. Accuracy of those are 48%,70%,58%,67% and 56%. Conclusions：Among all the non-invasive examinations, ultrasound of carotid artery has the highest sensitivity followed by treadmill; echocardiography has the best specificity while treadmill has the best accuracy. Menopausal middle-aged and elderly population was more susceptible for female coronary heart disease. Perimenopausal population usually had low incidence unless the patient was accompanied by diabetes.Meanwhile,they usually had multiple-vessel disease.Patients with chest pain as well as hypertension,diabetes and hyperlipidemia should receive coronary angiography as soon as possible even without abnormality in non-invasive examinations.