【作者】 李晓枫；

【导师】 方丕华； 陈柯萍； 任晓庆；

【作者基本信息】 中国协和医科大学 ， 心血管内科学， 2009， 硕士

【摘要】 【目的】通过大样本资料分析我国行平板运动试验的人群特点,研究平板运动试验对于冠心病的诊断价值。【方法】回顾性分析2003年至2007年间于我院行平板运动试验患者。筛选出疑诊为冠心病、同期先后行平板运动试验和冠状动脉造影检查者,以冠状动脉造影结果作为冠心病诊断的金标准来评价平板运动试验对冠心病的诊断价值。【结果】41574例行平板运动试验受检者,平均年龄49.77±10.76,其中男占23030(占55.4%),女性18544(占44.6%)。女性平均年龄高于男性(p＜0.05),40～60岁年龄组所占比例最大(65.08%)。总体阳性率为4.48%,且随年龄增加而递增,男性阳性率高于女性(5.86%vs.2.77%,p＜0.05)。伴有临床症状的疑诊冠心病者在总受检者所占比例最高(88.55%)。平板运动试验导致的死亡1例(死亡率为0.24/万);运动过程中心电图出现ST段抬高者10例(发生率为2.4/万);室性心动过速6例(发生率为1.4/万),运动试验后发生窦性停搏发生率2例(0.48/万)。525例疑诊为冠心病、同期先后行平板运动试验和冠状动脉造影检查的患者平均年龄53.09±9.27(27～77岁),其中男性389例(占74.1%),女性136(占25.9%)。平板运动试验诊断冠心病的敏感性为60.66%,特异性为81.14%。男性患者的敏感性、特异性均高于女性(p＜0.05)。单支与双支病变敏感性无差异(p＞0.05),三支病变的敏感性高于单支及双支(p＜0.05)。左主干的病变组敏感性高于非左主干病变组,但无统计学差异(p＞0.05)。平板运动试验对前降支(LAD)、回旋支(LCX)、右冠状动脉(RCA)的检出率分别为47.3%、57.14%、36.36%,对不同病变位置的敏感性相似(p＞0.05),且狭窄50%及75%以上两组结果相同。糖尿病患者平板运动试验的敏感性为77.78%,特异性为95.45%(n=67);高血压患者平板运动试验敏感性为61.27%,特异性为97.87%(n=236)。年龄、高血压、吸烟为平板运动试验结果为假阳性的独立影响因素;性别、年龄、冠状动脉病变数目、血管闭塞性病变、累及分支病变、存在侧支循环及高脂血症者是假阴性结果的独立影响因素。【结论】平板运动试验应用广泛、较安全。作为冠心病的无创性辅助诊断试验,其敏感性中等,易受冠状动脉病变数目及严重程度而非病变部位的影响,但特异性较高。对于男性、伴糖尿病或高血压患者诊断冠心病的价值更高,结合多因素分析平板运动试验结果有助于提高试验的准确性。更多还原

【Abstract】 [Objective]To investigate the characteristics of patients who underwent Exercise Treadmill Test(ETT) in Fu Wai Hospital and to evaluate the value of ETT for diagnosis of Coronary Artery Disease(CAD) by means of[Methods]41574 consecutive subjects admitted to Fu way Hospital and underwent an ETT from 2003 to 2007 were analysed retrospectively.In order to evaluate the value of ETT for diagnosis of CAD,comparative analysis.was specially focused on those patients who were suspected for CAD and underwent both ETT and Coronary Angiography (CAG)[Result]41574 patients underwent ETT during the study period.Among them men were 23030(55.4%) and women were 18544(44.6%) with mean age of 49.77±10.76 years.The mean age of the women was higher than the men(p＜0.05).Patients with age of 40～60 years accounted for 65.08%.The total positive rate of exercise treadmill test was 4.48%,which increased with age and the positive rate in the men was also higher than in the female(5.86%vs.2.77%,p＜0.05).The patients with symptom and suspected CAD accounted for the largest part of the total population(88.55%).Death related with ETT was one(0.24/10000).The incidence of ST-elevation and ventricular tachycardia were 2.4/10000(n=10) and 1.4/10000(n=6) respectively.Two patients developed sinus arrest after the test.525 patients suspected for CAD underwent both ETT and CAG.The mean age of the patients was 53.09±9.27 years.Among them,men were 389(74.1%) and women were. 136(25.9%).The sensitivity and the specificity of ETT for diagnosis of CAD were 60.66%and was 81.14%respectively.Both of the sensitivity and specificity in the men was higher than in the women(p＜0.05).There was no significant difference in the sensitivity of ETT between one-vessel diseased group and two-vessel diseased group. But the three-vessel diseased group was higher than one or two-vessel diseased group (p＜0.05).The sensitivity of ETT in LM group was higher than in non-LM group,but there is no statistically difference(p＞0.05).The sensitivity of ETT for LAD,LCX and RCA were 47.3%,57.14%,36.36%respectively.The results suggested that the sensitivity of ETT for different vessel was similar in both of more than 50%or 75%luminal occlusion group.Sensitivity of ETT for diagnosis of CAD in patients with diabetes mellitus(DM)(n=67) and hypertension(n=236) were 77.78%and 61.27%respectively, and the specificity was 95.45%and 97.87%respectively.Logistic regression analysis demonstrated that the age,hypertension and smoking are impact factors of false positive, whereas gender,age,number of diseased vessels,vessel occlusion,branch involvement, coronary collateral vessels and hyperlipemia are independent impact factors of false negative ETT results.[Conclusion]ETT was a safe and frequently used as a noninvasive diagnostic test of CAD.It had moderate degree sensitivity which was affected by number and extent of stenos is vessels rather than the position of diseased vessel.The specificity of ETT is high.The diagnostic of ETT may be more valuable in men,DM or hypertension patients. Analysis of the result of ETT combining with multiple clinical factors will improve the accuracy of diagnosis of CAD更多还原