平板运动试验诊断冠心病准确性影响因素分析

Exercise treadmill test in the diagnosis of coronary heart disease（CHD） factors affecting the accuracy of analysis

目的 分析影响平板运动试验（TET）诊断冠心病准确性的因素.方法 选取我院2012年6月至2014年10月收治疑似冠心病且最终行CAG的448例患者,研究患者性别,冠脉病变部位和狭窄程度,心肌桥,危险因素如高血压、糖尿病、高脂血症、吸烟史对TET诊断冠心病准确性的影响.结果 TET对不同性别患者及不同病变位置（冠脉狭窄程度＞50％）的检出率未见统计学差异（P＞0.05）,但在冠状动脉狭窄程度＞70％的患者中,TET的检出率差异有统计学意义（P＜0.05）;TET对不同冠脉狭窄程度的检出率差异有统计学意义（P＜0.05）.糖尿病、高血压患者行TET诊断冠心病,其特异性、阳性预测值、预测准确性均大于非糖尿病、非高血压患者,差异有统计学意义（P＜0.05）.高脂血症、伴有侧支循环、血管闭塞是TET产生假阴性结果的独立影响因素,高血压、吸烟史是TET产生假阳性结果的独立影响因素.结论 TET诊断冠心病结果的准确性受患者冠脉狭窄程度、病变位置及多种临床病史及危险因素的影响,充分了解TET假阳性和假阴性产生的原因,并结合患者临床特征和其他合并症,可有效提高TET评估的准确性和预测能力.

Objective To analyze the factors affecting the accuracy of diagnosis of coronary heart disease using treadmill exercise testing （TET）. Methods 448 patients who were treated with coronary heart disease from June 2012 to October 2014 were selected, the factors of personal characteristics （gender）, disease （percent steno- sis, lesions and myocardial bridge ） and clinical history and risk factors （hypertension, diabetes, hyperlipidemia, smoking history）may affect the accuracy of treadmill exercise test for coronary artery disease were analyzed. Re- suits The diagnostic of TET in different gender of coronary heart disease has no statistically significant difference （P〉0.05）, but there was significant difference of detectable rate for percent stenosis and lesion location（Larger than 70% ） using TET （P〈0.05）. The diagnostic of TET in coronary heart disease with diabetes, hypertension, specificity, positive predictive value, forecast accuracy were greater than non-diabetic, non-hypertensive patients, and there was a statistically significant difference（P〈0.05 ）. Hyperlipidemia, accompanied by collateral circulation, vessel occlusion were the independent factors to produce false negative results, and history of high blood pressure, smoking were the independent factors to produce false-positive results. Conclusion Percent stenosis, lesion loca- tion, various clinical history and risk factors of patient affect the accuracy of treadmill exercise test in diagnosis of coronary heart disease. Studying the reason of false-positive and false-negative, combined with clinical characteris-tic and other complications can improve the accuracy of diagnosis.