非典型心绞痛人群冠心病诊断评分方案的创建及冠状动脉CT检查对其的影响

Establishment of a scoring scheme for diagnosis of coronary heart disease in patients with atypical angina and effect of coronary computerized tomographic scanning on it

目的建立预测非典型心绞痛冠状动脉粥样硬化性心脏病(冠心病)可能性的诊断评分系统。方法回顾性分析3 420例入院疑诊冠心病且具有非典型心绞痛症状表现的患者的临床资料,对相关临床因素进行Logistic多因素回归分析,筛选危险因素并对危险因素依据比数比(odds ratin,OR)值分别赋予分值,同时计算危险得分,建立非典型心绞痛冠心病诊断评分方案。分析危险积分和冠心病发病率、冠状动脉病变程度的关系。通过计算受试者工作特性(receiver operating characteristics,ROC)曲线下面积检验该评分方案的应用效能。对冠状动脉计算机断层扫描(computerized tomographic scanning,CT)检查行危险因素分析,依据OR值赋值,将冠状动脉CT纳入诊断评分方案后计算ROC曲线下面积,检验评分方案应用效能的变化。结果非典型心绞痛冠心病发病率为63.68%。年龄、男性、吸烟史、糖尿病史、原发性高血压史及血脂异常为诊断评分方案(命名为ABCDDS方案)的6个因素。诊断评分方案ROC曲线下面积为0.723,标准误为0.010。危险积分范围:0～11分。危险积分越高,患者患冠心病的可能性越大。随着危险积分分值的增加,冠心病病变程度越重。冠状动脉CT积分7分,冠状动脉CT纳入诊断评分方案后,ROC曲线下面积增加至0.832。结论非典型心绞痛冠心病诊断评分方案简单、实用,可有效预测非典型心绞痛冠心病。冠状动脉CT可提高诊断评分方案的应用效能。

Objectives To establish an efficient diagnostic scoring system to predict prevalence of coronary heart disease（CHD） in patients with atypical angina.Methods By retrospectively studing a database of 3 420 patients with atypical angina and with suspected CHD,risk factors were selected from clinical factors examined through multivariate logistic analysis and were assigned according to odds ratio（OR）.Risk points are calculated and ascoring system for diagnosis of CHD with atypical angina was established.Correlations between risk score and prevalence of CHD as well as between risk score and coronary artery lesion severity were analyzed.Application efficiency of diagnostic scoring scheme was tested by calculating area under the receiver operating characteristic（ROC） curve.Coronary computerized tomographic scanning（CT） was conducted a risk factor analysis and assigned according to OR.Considering coronary CT was as one of the factors for diagnostic scoring scheme,the new area under the ROC curve was calculated to examine the application efficiency of new scheme.Results Prevalence of CHD is 63.68% in this study.Age,male,smoking,hypertension,diabetes mellitus and dyslipidemia were 6 risk factors for diagnostic scoring system named as ＂ABCDDS＂.Area under the ROC curve of diagnostic scoring scheme was 0.723 and standard error was 0.010.Range of risk score in diagnostic scoring scheme was from 0 to 11.The higher the score in the diagnostic scoring scheme was,the higher potentiality of CHD in a patient with atypical angina,and the more serious the coronary artery disease was.Score of coronary CT was 7.Area under the ROC curve of diagnostic scoring scheme increased to 0.832 when coronary CT was included.Conclusions Diagnostic scoring scheme is simple and practical for efficiently predicting probability of CHD in patients with atypical angina,and its application can be improved by coronary CT.