64层螺旋CT冠状动脉血管成像联合血脂检测对老年冠心病的诊断价值

The diagnostic value of multi-slice spiral CT coronary angiography combined with lipid levels in elderly coronary heart disease

目的探讨64层螺旋CT冠状动脉血管成像(64-SCTCA)与血脂水平变化对老年冠心病的临床诊断价值。方法回顾性分析重庆市中医院2010年8月至2012年12月90例接受64-SCTCA检查、并于4周内接受冠状动脉造影(CAG)检查的老年冠心病疑诊患者的临床资料。依据冠心病概率杜克模型,将受检者分为冠心病低风险组、中风险组和高风险组3组,每组各30例,以CAG检查结果为金标准,检测血脂变化,判断64-SCTCA与血脂水平诊断冠心病的准确性。结果 64-SCTCA诊断疑似冠心病的灵敏性、特异性、阳性预测值、阴性预测值、准确率分别为91.30%(42/46),90.24%(37/41),85.71%(42/49),90.24%(37/41)和87.78%(79/90)。而低风险组64-SCTCA诊断老年冠心病的灵敏性、阳性预测值和准确率均明显低于中、高风险组,差异有统计学意义(P<0.05)。同时,冠脉狭窄时,血浆总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇均出现不同程度的改变,差异有统计学意义(P<0.05)。结论 64-SCTCA对冠心病患者有较高的筛选价值,而血脂变化可有效判断冠状动脉狭窄程度。

Objective To explore the value of clinical diagnosis of the 64-slice spiral CT coronary angiography （64-SCTCA）and serum lipid levels in coronary heart disease （CHD） .Methods Retrospectvely analyzed 90 elderly patients who received 64-SCTCA examination and taken coronary angiography （CAG）within 4 weeks .Based on the probability of CHD Duke model ,the subjects were divided into three groups ,including low ,middle and high risk group ,and 30 patients in each group .Taking CAG as the “gold standard” ,the accuracy of the estimation of 64-SCT-CA and blood lipid level was tested .Results The sensitivity ,specificity ,positive predictive value ,negative predictive value ,accuracy rate of 64-SCTCA in diagnosis of suspected CHD ,were 91 .30% （42/46） ,90 .24% （37/41） ,85 .71%（42/49） ,90 .24% （37/41）and 87 .78% （79/90）respectively .The sensitivity ,positive predictive value and accuracy ate of 64-SCTCA in diagnosis of elderly CHD in low risk group were significantly lower than those in middle and high risk group（P〈 0 .05） .TC ,TG ,LDL-C and HDL-C were significantly changed when the coronary artery stenosis （P〈0 .05） .Conclusion 64-SCTCA is useful in CHD screening and the blood lipid changes could be useful for diagnosing the degree of coronary artery stenosis .