多层螺旋CT诊断冠心病的敏感性及相关影响因素分析

Sensitivity of Multi-slice Spiral CT in the Diagnosis of Coronary Heart Disease and Related Influencing Factors

目的探究多层螺旋CT(MSCT)诊断冠心病的敏感性及相关影响因素分析。方法回顾性分析2015年7月至2017年7月我院收治的88例冠心病患者的临床资料,所有患者均行MSCT及冠状动脉造影(CAG)检查,以CAG检查结果作为金标准,计算MSCT诊断冠心病的诊断效能,并比较不同性别、年龄、钙化积分、心率及心率波动患者冠状动脉成像(CTA)的诊断敏感性。结果 MSCT评估冠脉狭窄的灵敏度为87.41%,特异度为95.60%,阳性预测值为93.08%,阴性预测值为89.79%,准确率为94.49%,CTA与CAG在冠状动脉狭窄性病变的诊断上具有较好的一致性(Kappa=0.836);不同钙化积分组诊断敏感性差异显著(P<0.05),低钙化积分诊断敏感度显著高于重度钙化积分组(P<0.05);心率波动<15次/min患者诊断敏感度显著大于心率波动≧15次/min患者(P<0.05)。结论 MSCT评估冠心病的诊断有较高的特异度、灵敏度、阴性预测值及准确性,与CAG诊断结果有较高的一致性;严重钙化及较大的心率波动可降低MSCT诊断敏感性。

Objective To explore the sensitivity of multi-slice spiral CT(MSCT) in the diagnosis of coronary heart disease(CHD) and related influencing factors. Methods The clinical data of 88 patients with CHD admitted to the hospital from July 2015 to July 2017 were analyzed retrospectively. All patients underwent MSCT and coronary angiography(CAG) examination. With the results of CAG as the golden standard, the diagnostic efficiency of MSCT for CHD was calculated. The diagnostic sensitivity of coronary artery imaging(CTA) was compared between different gender, age, calcification scores, heart rate and heart rate fluctuations. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of MSCT in the diagnosis of CHD were 87.41%, 95.60%, 93.08%, 89.79% and 94.49%, respectively. There was a good consistency between CTA and CAG in the diagnosis of coronary artery stenosis(Kappa=0.836). The diagnostic sensitivity of low calcification scores was significantly higher than that of severe calcification scores(P<0.05), and the diagnostic sensitivity in patients with heart rate fluctuation < 15 beats/min was significantly greater than that in patients with heart rate fluctuation ≧ 15 beats/min(P<0.05). Conclusion The specificity, sensitivity, negative predictive value and accuracy of MSCT are high in the diagnosis of CHD, with high consistency with the diagnostic results of CAG. Severe calcification and faster heart rate fluctuation will decrease the diagnostic sensitivity of MSCT.