心肌灌注显像与双源CT冠状动脉成像对糖尿病并发冠心病患者冠状动脉狭窄诊断价值的比较

Comparison of diagnostic values between myocardial perfusion imaging and dual source CT coronary angiography in coronary artery stenosis in patients with diabetes complicated with coronary heart disease

目的:评估并比较心肌灌注显像(MPI)与双源CT冠状动脉成像(DS-CTCA)检查对糖尿病并发冠心病(CHD)患者冠状动脉狭窄的诊断价值,阐明2种检查方法联合对糖尿病并发CHD患者的临床应用价值。方法:选取52例诊断为糖尿病并发CHD患者,分别接受MPI与DS-CTCA检查,比较2种检查方法诊断左主干(LM)、左前降支(LAD)、左回旋支(LCX)和右冠状动脉(RCA)等冠状动脉主干分支狭窄程度的差异。以冠状动脉血管造影(CAG)为金标准,比较2种检查方法单独诊断的灵敏度、敏感度和准确度的差异,比较2种检查方法联合平行诊断与系列诊断的灵敏度、敏感度和准确度的差异。结果:MPI检查与DS-CTCA检查对LM和LAD的狭窄程度诊断差异无统计学意义(P>0.05),对LCX和RCA的狭窄程度诊断差异有统计学意义(P<0.05)。与MPI检查比较,DS-CTCA检查对糖尿病并发CHD患者冠状动脉分支血管狭窄诊断的灵敏度较低,为71.0%vs 90.1%,差异有统计学意义(P=0.035);特异度较高,为85.7%vs 58.4%,差异有统计学意义(P=0.027);但2种检查方法的准确度为76.4%vs 78.4%,差异无统计学意义(P=0.062)。与平行诊断比较,系列诊断的特异度及准确度较高,分别为93.5%vs 33.8%和94.7%vs 71.2%,差异均有统计学意义(P=0.001,P=0.030);灵敏度为95.4%vs 93.1%,差异无统计学意义(P=0.074)。结论:DS-CTCA检查与MPI检查在诊断糖尿病并发CHD患者冠状动脉狭窄的准确度上无差异,但是2种检查方法的系列诊断能更加有效地提高诊断糖尿病并发CHD患者冠状动脉狭窄的准确度。

Objective:To evaluate and compare the diagnostic values between myocardial perfusion imaging(MPI)and dual source CT coronary angiography(DS-CTCA)in coronary artery stenosis in the diabetic patients with coronary heart disease(CHD),and to elucidate the clinical application values of MPI combined with DS-CTA in the diabetic patients with CHD.Methods:A total of 52 diabetic patients with CHD underwent the examinations of MPI and DS-CTCA were selected.The degrees of coronary artery stenosis of branches of coronary artery were compared between MPI examination and DS-CTCA examination,including left main coronary artery(LM),left anterior descending coronary artery(LAD),left circumflex branch(LCX)and right coronary artery(RCA).Based on the coronary angiography(CAG)regarded as the golden standard,the specificity,sensitivity and accuracy of each imaging examination method were compared;the specificities,sensitivities and accuracies of parallel diagnosis and serial diagnosis of two kinds of methods were also compared.Results:The stenosis degrees of LM and LAD were no different between MPI examination and DS-CTCA examination(P>0.05),but the stenosis degrees of LCX and RCA were different between two imaging examination methods(P<0.05).Compared with MPI examination,the sensitivity of DS-CTCA examination in the diabetic patients with CHD was decreased(71.0%vs 90.1%),and the difference was significant(P=0.035);the specificity of DS-CTCA examination in the diabetic patients with CHD was increased(85.7%vs 58.4%),and the difference was significant(P=0.027);but the accuracies of two examinations in the diabetic patients with CHD were no different(76.4%vs 78.4%)(P=0.062).Compared with parallel diagnosis,the specificity and accuracy of serial diagnosis were increased(93.5%vs 33.8%,P=0.001;94.7%vs 71.2%,P=0.030);but the sensitivities had no difference(95.4%vs 93.1%,P=0.074).Conclusion:The diagnostic accuracy of evaluating the degree of coronary artery stenosis in the diabetic patients with CHD is not different between DS-CTCA examination and MPI examination.And the serial diagnosis of two examination methods can improve the diagnostic accuracy.