64排螺旋CT冠脉成像与冠状动脉造影对高龄冠心病诊断的对比研究

Comparison between 64-slice spiral computed tomography and coronary angiography for diagnosing coronary heart disease in elderly patients

目的：评价64排螺旋CT冠脉成像（64-SCTCA）对高龄冠心病患者冠状动脉狭窄病变的临床诊断价值。方法：2010年1月~2011年1月期间住院的16例临床诊断或疑诊冠心病的高龄（≥60岁）患者,先后行64-SCTCA和冠状动脉造影（CAG）检查,参照美国心脏协会冠状动脉分段法对冠状动脉进行分段,评价64-SCTCA诊断高龄冠心病患者冠状动脉各节段狭窄病变的敏感性、特异性、准确性及阳性、阴性预测值。结果：（1）在CAG可清晰显影的144个节段中,64-SCTCA可清晰辨认和评价的占139段（96.53%）,另外5段（3.47%）显影不清。左主干、前降支及左回旋支可评价节段的比例显著高于右冠状动脉（χ2=10.36,P=0.016）,同一支血管中近、中、远段可评价的比例无显著性差异（P〉0.05）。（2）64-SCTCA诊断冠心病的敏感度、特异度、准确度、阳性和阴性预测值分别为88.89%、71.43%、81.25%、80.00%、83.33%。按可评价节段计算,64-SCTCA诊断冠状动脉各节段有意义狭窄病变总的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为85.00%、97.58%、95.83%、85.00%、97.58%。（3）按可评价节段计算,64-SCTCA检出存在有意义病变与CAG相比无显著性差异,检测左主干、左前降支、左回旋支和右冠状动脉各节段病变及同一支血管近、中、远段的假阳性率比较,差异均无统计学意义（P〉0.05）。结论：64-SCTCA与CAG检查结果高度相近,对冠状动脉狭窄病变有较好的诊断价值,其检测左主干、左前降支和左回旋支病变的价值高于右冠状动脉,对临床诊断冠心病有着重要的参考价值。

Objective： To evaluate the clinical value of 64-slice spiral computed tomographic coronary angiography（64-SCTCA） for diagnosing the significant stenosis of coronary artery in elderly patients.Methods： Both 64-SCTCA and coronary angiography（CAG） were performed on 16 elderly patients aged over 60 from January 2010 to January 2011.Coronary artery was segmented according to segmenting method of American Heart Association,and sensitivity,specificity,accuracy,positive and negative predictive rate of 64-SCTCA in diagnosis of coronary artery stenosis were evaluated.Results： In the 144 segments assessable by CAG,139（96.53%） were clear enough for identification and evaluation by 64-SCTCA,while 5 were unclear.There were more clear segments in the left main,left anterior descending and left circumflex coronary arteries than in the right coronary arteries（χ2=10.36,P=0.016）.There was no significant difference in amount of clear segments among proximal segments,middle segments and distal segments（P0.05）.The sensitivity,specificity,positive and negative predictive value,accuracy of 64-SCTCA for diagnosing coronary artery disease were 88.89%,71.43%,81.25%,80.00%,83.33%,respectively.The calculation of assessable segments by 64-SCTCA showed the sensitivity,specificity,positive and negative predictive value,accuracy of 64-SCTCA for segmental coronary stenosis were 85.00%,97.58%,95.83%,85.00% and 97.58%,respectively.The diagnostic value of 64-SCTCA for significantly segmental coronary stenosis was similar to CAG,and was similar in left main,left anterior descending,left circumflex coronary arteries and right coronary artery,as well as in proximal,middle and distal segments.Conclusions： 64-SCTCA in as valuable as CAG in diagnosis of coronary stenosis,with a significantly higher accuracy in the left main,left anterior descending,left circumflex coronary arteries and the proximal,middle segments.