计算机断层扫描血管成像检查对冠状动脉临界病变的诊断价值

Diagnostic value of computed tomography angiography in intermediate lesions of coronary artery stenosis

目的探讨计算机断层扫描血管成像(CTA)检查对冠状动脉临界病变的诊断价值。方法收集2019年1月至2021年5月于皖南医学院附属太和医院行冠状动脉CTA和冠状动脉造影(CAG)检查的82例患者的临床资料,以CAG检查结果为金标准,分析CTA检查对冠状动脉临界病变的诊断效能。结果CAG检查共检出251处冠状动脉狭窄病变,其中轻度狭窄53处,中度狭窄137处,重度狭窄及闭塞病变61处。在CTA检查中,3处轻度狭窄病变未被检出,1处轻度狭窄病变被判断为中度狭窄病变,3处重度狭窄病变被判断为中度狭窄病变。CTA检查诊断冠状动脉临界病变的灵敏度为95.6%,特异度为93.9%,阳性预测值为94.9%,阴性预测值为94.7%,准确度为94.8%(P<0.01)。受试者操作特征(ROC)曲线的曲线下面积为0.903。在8例因中度狭窄且合并缺血症状的患者中,两种检查方法诊断的中度狭窄程度比较,差异无统计学意义(P>0.05)。结论CTA诊断冠状动脉临界病变准确、简便,具有较高的诊断价值,对于未明确冠状动脉介入检查和治疗指征的患者具有较高的筛查能力,值得临床推广。

Objective To explore the diagnostic value of computed tomography angiography(CTA)in intermediate lesions of coronary artery stenosis.Method The data of 82 patients who received CTA and coronary angiography(CAG)in Wannan Medical College Affiliated Taihe Hospital from January 2019 to May 2021 were selected,and the result of CAG was used as the gold standard to compare the diagnostic value of CTA in intermediate lesions of coronary stenosis.Result CAG examination results showed a total of 251 coronary artery stenotic lesions,including 53 mild stenosis,137 intermediate lesions,and 61 severe or occlusion lesions.A total of 3 mild lesions were not detected on CTA,1 mild stenosis was judged as moderate stenosis on CTA and 3 severe stenosis as moderate stenosis on CTA.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CTA in the diagnosis of critical coronary artery disease were 95.6%,93.9%,94.9%,94.7% and 94.8%,respectively(P<0.01).The area under curve in receiver operator characteristic(ROC)was 0.903.In 8 patients with moderate stenosis and ischemic symptoms,there was no significant difference in the degree of moderate stenosis diagnosed by the two examination methods(P>0.05).Conclusion CTA diagnosis of critical coronary artery disease is accurate,simple,and has higher diagnostic value in intermediate lesions of coronary stenosis and higher screen ability for patients without established indication for coronary interventional examination and treatment,which is worthy of clinical promotion.