选择性冠脉造影对冠脉狭窄检出率及其影响因素的研究

Data analysis for the positive rate of selective coronary artery angiography and the risk factors in coronary artery stenosis

目的评估冠脉造影(CAG)对冠脉狭窄的检出率,并对与冠脉狭窄有关联的危险因素进行分析,为提高CAG阳性检出率提供依据。方法对2008年3月至12月CAG检查资料总结分析,观察左主冠状动脉(LM)、左主干分出的左前降支(LAD)、回旋支(LCX)及右冠状动脉(RCA)狭窄的阳性检出率。分类资料组间比较采用χ2检验,采用多项式Logistic回归模型分析有关联的危险性因素,依据发现的危险性因素建立判别分析方程,并采用ROC分析确定其预测诊断的灵敏度和特异度。结果按冠脉狭窄<25%为阴性的标准分析,CAG阳性检出率为64.21%,阴性检出率为35.79%,≤59岁的女性患者阴性检出率尤为突出。与冠脉狭窄相关危险因素包括:性别、年龄、糖尿病、高血压、吸烟;血生化指标包括:白蛋白/球蛋白、总胆汁酸、甘油三酯、高密度脂蛋白胆固醇、葡萄糖、肌酐、纤维蛋白原和血红蛋白(P<0.05)。依据非创伤性指标建立的判别方程预测冠脉狭窄的灵敏度为54.40%,特异度为89.90%。结论与冠脉狭窄有关联的危险性因素可以提高冠状动脉疾病的检出率。

Objective To evaluate the detection rate of coronary stenosis with coronary angiography （CAG） and ana- lyze the coronary risk factors associated with the coronary stenosis, in order to provide a basis for increasing the CAG- positive detection rate. Methods The data of patients with CAG test collected from March 2008 to December 2008 in Qilu Hospital of Shandong University were analyzed to observe the positive rate of LM, LAD, LCX and RCA. Chi- square test was used in the categorical data. Multinomial logistic regression analysis was used to evaluate the risk factors related to the coronary stenosis. A discriminate predicting score and receiver operating characteristic curve （ROC） anal- ysis were performed to evaluate the predictive diagnostic sensitivity and specificity. Results The diameter of coronary artery stenosis （CAS） 〉 25% was diagnosed as the positive event, and the positive rate of CAG was 64.21%. The positive rate of men with age ≤ 59 was 56.19%, and 32.47% for women with age ~〈 59. The negative rate of women was higher compared with the men. The risk factors associated with CAS were gender, age, diabetes, hypertension, smoking and the blood biochemical indicators including A/G, TBA, TG, HDL, GLU, Cr, FIB and HGB （P 〈 0.05）. The sensitivity and specificity were 54.40% and 89.90% based on the predicting score in the discriminate regression and ROC analysis. Conclusion The risk factors associated with CAS can enhance the detection rate of coronary artery stenosis （CAS）.