女性绝经前后运动平板试验假阳性率的对比研究

Comparative study of false positive rate of treadmill exercise test in women before or after menopause

目的分析在胸痛患者中运动平板试验阳性对冠心病的诊断符合率。比较男性组、女性绝经前组、绝经后组运动平板假阳性率的差异。方法运动平板试验均采用Bruce方案,使用美国GE公司CardioSys-CE-0459运动平板机。对268例临床有胸痛症状的运动平板试验阳性患者行冠状动脉(冠脉)造影检查,冠脉狭窄≥50%诊断为冠心病。以冠脉造影结果为金标准,比较男性组(146例)、女性绝经期前组(39例)及绝经期后组(83例)运动平板试验的假阳性率。结果冠脉造影确诊冠心病176例(65.67%),其中男性105例,女性71例;冠脉造影阴性者92例(34.33%),男性41例,女性51例。女性绝经后组〔30.12%(25/83)〕与男性组〔28.08%(41/146)〕比较,运动平板的假阳性率差异无统计学意义(χ2=0.107,P=0.428),绝经前组〔66.67%(26/39)〕与男性组(28.08%)及绝经后组(30.12%)比较差异均有统计学意义(χ2=19.83,P=0.000;χ2=14.57,P=0.000)。结论胸痛患者在冠脉造影前行运动平板试验筛查,阳性者再行冠脉造影可大大提高冠脉造影检查的阳性率。与绝经后组及男性组比较,绝经期前女性运动平板试验假阳性率较高,绝经后女性与男性无明显差异。

Objective To analyze the coincidence rate of positive treadmill exercise testing（TET）and coronary angiography（CAG）for diagnosis of coronary artery disease（CAD）in suspected CAD patients with chest pain.Methods TET was performed using CardioSys-GE-0459 treadmill exercise apparatus and adopting Bruce scheme in 268 patients with chest pain,then CAG was performed in positive TET patients.Taking the CAG result as＂gold standard＂（CAD was defined as coronary stenosis≥50%）,the false positive rates of TET were compared in the male group（146 cases）,pre-and post-menopause groups（39 cases and 83 cases,respectively）.Results Of 268 cases,176（105 male and 71 female） were diagnosed as CAD by CAG（positive rate was 65.67%）,and 92（41 male and 51 female,respectively）were negative in CAG（34.33%）.The false positive rates of TET between post-menopause group and male group had no statistical difference（30.12%（25/83） vs 28.08%（41/146）,χ2=0.107,P=0.428）,while The false positive rate of TET in pre-menopause group（66.7%（26/39））obviously higher compared with post-menopause group（30.12%） and male group（28.08%）（χ2=14.57,P=0.000;χ2=19.83,P=0.000）.Conclusions Performing TET screening first for patients with chest pain,then carrying out CAG for TET positive patients could greatly elevate positive rate of CAG.TET false positive rate of pre-menopause female is higher than those of post-menopause female or male,and there is no difference in post-menopause female and male.