室性心律失常在冠状动脉粥样硬化性心脏病诊断中的价值评估

Evaluation of the ventricular arrhythmia in diagnosing Coronary Artery Disease

目的探讨室性心律失常对冠状动脉粥样硬化性心脏病(冠心病)的诊断价值和实用性。方法回顾性分析229例具备2个以上冠心病前置危险因素且行心电图和动态心电图检查及冠状动脉造影的住院患者资料,其中室性心律失常127例,运动平板试验阳性合并室性心律失常72例,经冠状动脉造影确诊为冠心病并行冠状动脉支架术者99例。利用临床流行病学方法分别计算室性心律失常及运动平板试验阳性合并室性心律失常对冠心病诊断的灵敏度、特异度、阳性预测值、阴性预测值,阳性似然比、阴性似然比及患病率。采用配对卡方检验支架术前后室性心律失常的发生率有无差别。结果 (1)室性心律失常对冠心病诊断的灵敏度和特异度分别为55.65%、44.76%;阳性预测值和阴性预测值分别为54.33%、46.08%;阳性似然比和阴性似然分别为比为1.01、0.99;患病率为52.7%。(2)运动平板试验阳性合并室性心律失常对冠心病诊断的灵敏度和特异度分别为74.58%、45.10%;阳性预测值和阴性预测值分别为61.11%、60.53%;阳性似然比和阴性似然比分别为1.36、0.56。(3)冠状动脉支架术治疗前、后室性心律失常发生率比较差异无统计学意义(P>0.05)。结论室性心律失常对冠心病的诊断价值有限,其诊断价值与所处医院冠心病患病率有关。运动平板试验阳性合并室性心律失常对诊断冠心病有一定价值。冠状动脉支架术对心肌血流再灌注的改善并未显示出对室性心律失常发生率的影响。以室性心律失常发生率有无变化评价血管再通术后缺血区心肌组织是否受益亦较为困难。

Objective To explore the value and practicability of the ventricular arrhythmia in diagnosing coronary artery disease （CAD）.Methods A total of 229 patients with two or more risk factors of CAD underwent coronary angiography （CAG） and ECG were retrospectively analyzed.In all of these patients,there were 127 patients whom have been diagnosed ventricular arrhythmia,and among these patients there were 72 patients whom have been diagnosed positive in ECG exercise testing,and there were 99 patients whom have been diagnosed CAD by CAG also underwent percutaneous transluminal coronary angioplasty （PTCA）.Then we use the clinic epidemiology method to analyze the sensitivity,specificity,positive predictive value,negative predictive value,Positive likelihood ratio chi-square,and negative likelihood ratio chi-square and prevalence rate of ventricular arrhythmia and ECG exercise testing combination with ventricular arrhythmia.Using the chi-square test to compare the incidence rate of ventricular arrhythmia before and after PTCA.Results （1） Sensitivity and specificity of ventricular arrhythmia were 55.65% and 44.76%.Positive predictive value and negative predictive value were 54.33% and 46.08%.Positive likelihood ratio chi-square and negative likelihood ratio chi-square were 1.01 and 0.99,prevalence rate was 52.7%.（2） Sensitivity and specificity of ECG exercise testing combination with ventricular arrhythmia were 74.58% and 45.10%.Positive predictive value and negative predictive value were 61.11% and 60.53%,Positive likelihood ratio chi-square and negative likelihood ratio chi-square were 1.36 and 0.56.（3）The results of chi-square test indicate that incidence rate of ventricular arrhythmia before and after PTCA have no statistical significance （P0.05）.Conclusion The value of the ventricular arrhythmia in diagnosing coronary artery disease is finite,and the value is relative to prevalence rate of the hospital.The value of ECG exercise testing combination with ventricular arrhythmia in diagnosing coronary artery disease is to a certainty.PTCA has no influence to incidence rate of ventricular arrhythmia.It is difficult to use the change of incidence rate of ventricular arrhythmia to evaluate whether ischaemic cardiac muscle had benefit from PTCA.