静息心肌透壁灌注指数(TPR)对冠心病附加诊断价值

Resting transmural perfusion ratio(TPR) in the diagnosis of coronary artery disease

目的探讨静息状态下心肌透壁灌注指数（TPR）能否提高冠状动脉CT血管造影（CCTA）对冠心病诊断的准确性。方法回顾性分析2015年1～10月临床疑诊为冠心病并于CCTA后2周内完成冠脉血管造影（CAG）检查病例，共270例入选。应用CCTA的原始数据进行TPR分析，以CAG结果为参照，评价CCTA联合TPR对冠心病的诊断价值。结果单独CCTA以及联合TPR均可诊断冠心病（X2=146．2、141．9，P均〈0．01），受试者特征曲线（HOG）下面积分别为0．866、0．885。单独CCTA诊断冠心病的敏感性为93．5％（188／201），特异性为79．7％（55／69），阳性预测值为93．1％（188／202），阴性预测值为80．9％（55／68）。CCTA联合TPR诊断冠心病的敏感性为88．6％（178／201），特异性为88．4％（61／69），阳性预测值为95．7％（178／186），阴性预测值为72．6％（61／84）。结论TPR有助于提高CCTA诊断冠心病的准确性及特异性。

Objective To evaluate the diagnostic accuracy of electrocardiographically gated 320-row coronary computed tomographic angiography （CCTA） in combination with resting transmural perfusion ratio （TPR） in individuals without known coronary artery disease（CAD）. Methods A total of 270 cases clinical suspected coronary heart disease（CHD） conformed CCTA and CAG examination during January to October in 2015 were enrolled. TPR analysis was conduct- ed from CCTA original data. The value of CCTA in combination with TPR for diagnosing CHD was evaluated referring to CAG results. Results CCTA alone and combined with resting TPR could be used to diagnose CHD（x^2=146.2, 141.9, P〈0.01）, the areas under receiver operating characteristic curve （ROC） were 0.866,0.885. The sensitivity,specificity, positive predictive value（PPV） and negative predictive value （NPV） of CCTA diagnosis of CHD alone were 93.5% （188/ 201 ）, 79.7% （55/69）, 93.1% （ 188/202）, 80.9% （55/68）. Those of CCTA Combined TPR were 88.6% （ 178/201 ）, 88.4% （61/69）, 95.7%（178/186）, 72.6%（61/84）, respectively. Conclusion CHD could be diagnosed by CCTA in conjunction with resting TPR with improving accuracy and specificity.