两种危险因素定量评估系统对不典型胸痛患者冠状动脉病变程度预测的对比研究

Comparative study of two prediction scoring systems on patients with suspected coronary heart disease

目的探讨两种危险因素定量评估系统在预测不典型胸痛患者冠状动脉病变程度中的作用。方法入选疑诊冠心病(CHD)不典型胸痛患者272例,行冠状动脉造影(CAG)检查诊断为CHD的患者94例(CHD组),非CHD患者178例(非CHD组)。收集患者资料,分别导入PROCAM风险评分系统和冠状动脉病变程度预测评分系统(SCP评分系统),计算相应积分,采用Spearman法分析两种评分系统积分与冠状动脉SYNTAX积分间的相关关系,利用工作特征曲线(ROC)评价各评分系统的效能。结果所有患者的PROCAM积分为6.00~77.00(41.76±19.91)分,随着积分数值增加,其冠状动脉SYNTAX积分升高,两者呈正相关(rs=0.420,P=0.023)。所有患者的SCP积分为1.00~13.00(8.64±3.42)分,其积分数值亦与冠状动脉SYNTAX积分呈正相关(rs=0.482,P=0.016),且SCP积分的相关性更高。PROCAM积分ROC的曲线下面积(AUC)为0.770(P=0.007),SCP积分ROC的AUC为0.733(P=0.012),PROCAM积分ROC的AUC较大。结论两个评分系统均能对疑诊CHD患者的冠状动脉病变程度进行有效预测,与CAG结果均有较好的相关性。

Objective To investigate and compare the predictive value of 2 prediction scoring systems for diagnosis of coronary heart disease（ CHD） in patients with suspected symptom,and provide information for diagnosis and therapy. Methods By prospectively studying a database of 272 patients with suspected CHD,the total score was calculated by prediction scoring system including PROCAM（ The Prospective Cardiovascular Munster Study） and SCP（ Suspected CHD Prediction Scoring System） with the data of clinic parameters and risk factors. All patients received coronary angiography and they were categorized into the CHD group（ n = 94）and non CHD group（ = 178） according to the angiography result. The relationship between total scores and the SYNTAX score was evaluated by Spearman analysis and the value of the prediction scoring system was evaluated by the ROC（ receiver operating characteristic） system. Results The score of PROCAM was from6. 00-77. 00（ 41. 76 ± 19. 91）,and the score was significantly correlated with the extent and severity of coronary artery atherosclerosis（ rs= 0. 420,P = 0. 023）. The score of SCP was from 1. 00-13. 00（ 8. 64 ±3. 42）,and it was significantly correlated with the SYNTAX score（ rs= 0. 482,P = 0. 016）. The areas under ROC was 0. 770（ P = 0. 007） in PROCAM and that was 0. 733（ P = 0. 012） in SCP. Conclusions The nature and extent of coronary artery atherosclerosis could be evaluated by the scoring system effectively,which had a good correlation with CAG result.