验前概率和运动平板试验在女性可疑冠心病患者中的应用

Pre-test Probability and Exercise Plate Test in Women with Suspected Coronary Heart Disease

目的探索验前概率(pre-testprobability,PTP)和运动平板试验(exercisetreadmilltesting,ETT)在女性可疑冠心病患者中的应用价值。方法方便选取2015年1月—2018年5月因胸痛在福建医科大学附属第一医院心内科先后行ETT和冠状动脉造影(coronary angiography,CAG)的女性患者182个,以CAG结果为金标准,分析PTP、ETT及二者联用对冠心病的诊断价值。结果在182例入选患者中,使用升级的Diamond-Forrester法(updated Diamond-Forrester method,UDFM)估测患者的PTP倾向于低估患者的发病率(低PTP组:14.8%vs 21.5%;中PTP组:47.8%vs 52.5%);ETT诊断冠心病的敏感性为68.97%,特异性为60.48%,阳性预测值(PPV)为44.94%,阴性预测值(NPV)为80.65%;ETT在低PTP组中具有较高的NPV(88.06%),较所有患者及中PTP组(80.65%及61.54%)高(P=0.015)。结论 PTP和ETT不适合单独应用于女性冠心病患者的诊断,但二者联用可在一定程度上提高ETT在女性冠心病患者中的诊断准确性,特别是在排除诊断上,从而避免有创检查带来不必要的并发症及经济损失。

Objective To explore the application value of pre-test probability(PTP) and exercise plate test(exercisetreadmillinging,ETT) in women with suspected coronary heart disease.Methods Convenient select from January2015 to May 2018,182 women with ETT and coronary angiography(CAG) underwent chest ache in the First Affiliated Hospital of Fujian Medical University,and analyzed the CAG results as the gold standard.The diagnostic value of PTP,ETT and their combination in coronary heart disease.Results Of the 182 patients enrolled,the escalated Diamond-Forrester method(UDFM) estimated that patients’ PTP tends to underestimate the incidence of patients(low PTP group:14.8% vs21.5%;medium PTP group:47.8% vs 52.5%);ETT has a sensitivity of 68.97% and a specificity of 60.48% for diagnosis of coronary heart disease,a positive predictive value(PPV) of 44.94%,and a negative predictive value(NPV) of 80.65%;ETT in the low PTP group It had a higher NPV(88.06%),which was higher than all patients and the middle PTP group(80.65%and 61.54%)(P=0.015).Conclusion PTP and ETT are not suitable for the diagnosis of female patients with coronary heart disease alone,but the combination of the two can improve the diagnostic accuracy of ETT in women with coronary heart disease to some extent,especially in the diagnosis,so as to avoid invasiveness.The examination brings unnecessary complications and economic losses.