多层螺旋CT冠脉造影对急性冠脉综合征的诊断价值研究

Research on diagnosis value of multi spiral computed tomography coronary angiography for acute coronarysyndrome

目的探讨多层螺旋CT(multi spiral computed tomography, MSCT)冠脉造影对急性冠脉综合征(acute coronary syndrome, ACS)的诊断价值。方法选择2016年6月至2018年6月青岛市胶州中心医院收治的ACS患者400例,均采用Ingenuity CT型64排128层螺旋CT(PHILIPS公司)行MSCT冠脉造影检查,并以数字减影血管造影(digital subtraction angiography, DSA)结果作为ACS诊断的金标准,分析MSCT冠脉造影对ACS的诊断价值。结果在400例患者中,395例出现不同程度的冠脉狭窄,385例MSCT冠脉造影诊断ACS阳性。MSCT冠脉造影诊断ACS的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为98.97%(384/388)、91.67%(11/12)、99.74%(384/385)、73.33%(11/15)、98.75%(395/400),漏诊率为1.03%(4/388),误诊率为8.33%(1/12)。随着ACS危险因素的增多,MSCT冠脉造影诊断ACS的阳性率逐渐增高(P<0.05)。MSCT冠脉造影检出ACS合并轻中度冠脉狭窄或伴2～3个危险因素为主(P<0.05)。结论 MSCT冠脉造影可准确评定冠脉狭窄程度,对ACS具有明显的诊断价值,值得临床应用。

Objective To study the diagnosis value of multi spiral computed tomography(MSCT) coronary angiography for acute coronarysyndrome(ACS).Method 400 cases of patients with ACS during the period of June 2016 to June 2018 were selected as the research object,all patients were given MSCT coronary angiography by IngenuityCT 64 128 layers spiral CT(PHILIPS company),the examination resultof digital subtraction angiography(DSA) were as the gold standard for ACS diagnosis,the diagnosis value of ACS by MSCT coronaryangiography were analyzed.Result All for 400 patients,395 cases patient had different degree of coronary artery stenosis,385 cases werepositive for MSCT coronary angiography in the diagnosis of ACS.The sensitivity,speci?city,positive predictive value,negative predictivevalue and accuracy of MSCT coronary angiography in the diagnosis of ACS were 98.97%(384/388),91.67%(11/12),99.74%(384/385),73.33%(11/15),98.75%(395/400),the missed diagnosis rate was 1.03%(4/388),the misdiagnosis rate was 8.33%(1/12).As the increaseof the risk factors for ACS,positive rate of MSCT coronary angiography in the diagnosis of ACS was higher,P<0.05.MSCT coronaryangiography examination found that ACS was given priority to mild-to-moderate coronary stenosis,and was given priority to 2~3 riskfactors(P<0.05).Conclusion Diagnosis value of MSCT coronary angiography for ACS is signi?cant by accurately assessing coronarystenosis,it is worthy of clinical popularization and application.