心脏超声检查在冠心病节段性室壁运动异常鉴别诊断中的应用价值

Clinical value of echocardiography in differential diagnosis of segmental wall motion abnormalities in coronary heart disease

目的探讨心脏超声检查在冠心病节段性室壁运动异常鉴别诊断中的应用价值,为临床治疗提供帮助。方法选取2017年1月至2018年11月在余姚市人民医院就诊的冠心病节段性室壁运动异常患者56例为研究对象。所有患者分别采用心脏超声和冠状动脉造影两种方法进行诊断,评估心脏超声诊断的诊断符合率、特异性、灵敏度、假阴性率、假阳性率、准确性。结果冠状动脉造影检查显示冠心病节段性室壁运动异常者56例,符合率100.00%;经心脏超声检查显示冠心病节段性室壁运动异常者54例,2例显示节段性室壁运动正常,符合率96.43%,两种诊断方法符合率差异无统计学意义(χ^2=0.635,P=0.152),但心脏超声诊断特异度(80.36%)、灵敏度(78.57%)、准确率(80.36%)均低于冠状动脉造影检查(100.00%、98.21%、100.00%),差异均有统计学意义(χ^2=4.173,P=0.034;χ^2=5.154,P=0.024;χ^2=4.173,P=0.034)。结论心脏超声检查在冠心病节段性室壁运动异常鉴别诊断中具有较高的诊断价值,对临床上治疗该类患者制定合理的治疗方案具有指导作用,且心脏超声诊断技术操作简便、价格低,患者更容易接受。

Objective To explore the clinical value of echocardiography in differential diagnosis of segmental wall motion abnormalities in coronary heart disease(CHD), and to provide help for clinical treatment. Methods From January 2017 to November 2018, 56 patients with segmental abnormal wall motion of CHD in Yuyao People's Hospital of Zhejiang Province were selected in the study.All patients were diagnosed by echocardiography and coronary angiography.The diagnostic coincidence rate, specificity, sensitivity, false negative rate, false positive rate and accuracy of echocardiography were evaluated. Results Coronary angiography showed abnormal segmental wall motion in 56 patients, with 100.00% anastomosis rate.Echocardiography revealed abnormal segmental wall motion in 54 patients with CHD, 2 patients showed normal segmental wall motion, anastomosis rate was 96.43%.There was no statistically significant difference between the two diagnostic methods(χ^2=0.635, P=0.152), but the specificity of ultrasound diagnosis(80.36%), sensitivity(78.57%) and accuracy(80.36%) were lower than those of coronary angiography(100.00%, 98.21%, 100.00%), there were statistically significant differences (χ^2=4.173, P=0.034;χ^2=5.154, P=0.024;χ^2=4.173, P=0.034). Conclusion Cardiac echocardiography has a high diagnostic value in differential diagnosis of segmental wall motion abnormalities in CHD.It can guide the clinical treatment of these patients to formulate a reasonable treatment plan.Moreover, it is easy to operate, with low cost and more acceptable to patients.