核素心肌灌注显像和踏车运动试验对老年人冠心病的诊断价值

The diagnostic value of radionuclide cardiography and exercise bicycle test in elderly patients with coronary heart disease

目的 探讨核素心肌灌注单光子发射计算机断层显像 (SPECT)和踏车运动试验 (ET)对老年人冠心病的诊断价值。 方法 选取曾进行冠状动脉造影 (CAG)、且于造影前后 2个月内完成SPECT和ET的老年人 ,对其检查结果进行回顾性分析。将静息时SPECT的结果以心肌缺血程度和范围进行评分。计算ET心电图的最大ST/HR斜率 (maxST/HR)。 结果 以CAG结果作为金标准 ,114例患者中有 89例确诊为冠心病 ,2 5例排除冠心病。SPECT的敏感性和特异性分别为92 1%和 6 0 0 % ,ET则分别为 6 0 7%和 72 0 %。以maxST/HR≥ 2 2 μV/bpm作为判别标准 ,可以将冠心病诊断的敏感性和特异性分别提高至 80 9%和 80 0 %。以SPECT评分和ET的maxST/HR作为诊断指标 ,获得受试者工作曲线 (ROC曲线 )。两条曲线形态不同 ,但是ROC曲线下面积差异无显著性。 结论 SPECT评分和ET的maxST/HR都是较好的冠心病检测指标。对SPECT和ET的结果进行细致评价可以提高老年人冠心病诊断的准确率。

Objective To investigate the diagnostic value of radionuclide cardiography and exercise bicycle test for coronary heart disease (CHD) in elderly patients. Methods The retrospective analysis was performed for 114 patients received coronary angiography, 99mTc-MIBI radionuclide cardiography and exercise bicycle test within 2 months. The scores of myocardial ischemia in SPECT and the maximal ST/HR slope in ET were adopted for the quantitive analysis of CHD. The ROCs were plotted by SPSS 10.0. Results The coronary angiography showed positive in 89 and negative in 25 of the 114 patients. The sensitivity and specificity of SPECT were 92.1% and 60.0%, exercise bicycle test were 60.7% and 72.0%, respectively. When maximal ST/HR slope ≥2.2 μV/bpm was adopted as guideline of CHD, the sensitivity and specificity were 80.9% and 80.0% respectively. It showed that the maximal ST/HR slope was a better parameter than ordinary standard for exercise bicycle test. The ROCs of SPECT scores and the maximal ST/HR slope had different patterns from each other, although the areas under curves showed no significant difference. Conclusions The SPECT scores and maximal ST/HR slope are preferable indices in CHD diagnosed in elderly people. Careful evaluation of the results of SPECT and ET according to different conditions in different people may elevate the accuracy for diagnosing of CHD.