冠状动脉钙化积分在冠心病诊断中的价值

Value of coronary artery calcium score in the diagnosis of coronary artery disease

目的探讨冠状动脉(冠脉)钙化积分(CACS)在冠心病(CAD)诊断中的价值。方法70例疑诊CAD患者均行CACS和冠脉造影(ICA)检查,用受试者工作特征(ROC)曲线评价CACS诊断CAD的效能,计算冠脉四大分支血管的CACS,分析分支血管CACS与相应分支血管狭窄的相关性。结果 ICA金标准诊断CAD47例,非CAD23例。CAD组CACS高于非CAD组[(586.6±120.0)分vs.(69.7±67.1)分](P<0.01)。CAD组四大分支血管的CACS均高于非CAD组(P<0.01)。CACS诊断CAD的ROC曲线下面积为0.873,诊断CAD最佳界值为122分,灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为70.2%、95.7%、78.6%、97.1%和38.9%。分支血管CACS与相应分支血管狭窄呈正相关(r=0.59,P<0.01)。结论 CACS诊断CAD有一定价值,但不能全面评估冠脉狭窄程度。

Objective To evaluate the value of coronary artery calcium score（CACS）in the diagnosis of coronary artery disease（CAD）.Methods Seventy patients with suspected CAD were examined with CACS and invasive coronary angiography（ICA）.CACS of four major branch vessels of coronary artery was calculated.The performance of CACS in the diagnosis of CAD was evaluated by drawing receiver operation curve（ROC）.The correlation between CACS of branch vessels and stenosis of corresponding vessels was analyzed.Results With ICA as golden standard,CAD was diagnosed in47cases（group CAD）and non-CAD was confirmed in 23cases（goup non-CAD）.CACS was higher in group CAD than that in group non-CAD[（586.6±120.0）points vs.（69.7±67.1）points]（P〈0.01）.So did the CACS of four major branch vessels of coronary artery in group CAD（P〈0.01）.The area under ROC curve for CACS to diagnose CAD was 0.873.Taking 112 points as the best cutoff value,the sensitivity was 70.2%,specificity was 95.7%,accuracy was 78.6%,positive predictive value was 97.1%,and negative predictive value was 38.9%.CACS of branch vessels was positively correlated to the stenosis of corresponding vessels（r=0.59,P〈0.01）.Conclusion CACS has a certain value in the diagnosis of CAD,but can not comprehensively evaluate the severity of coronary stenosis.