目的研究多层螺旋CT（128- MSCTA）和冠状动脉造影（CAG）在冠心 病诊断中的比较分析。方法 对本院心血 管科就诊的患者进行随机选择，选出符 合条件的患者1640例，均进行128-MSCTA 和CAG，得到3168处狭窄动脉节段，比较 两法对狭窄程度的诊断情况，一致性以 及128-MSCTA的诊断准确性。结果 128- MSCTA诊断0级、1级、2级、3级和4级狭 窄的例数为1152例、396例、564例、564 例和492例；CAG分别为1164例、360例、 516例、612例和516例，两种方法比较无 统计学意义（P>0.05）。两组0级、1级、 2级、3级和4级狭窄分别进行一致性比 较，所得的Kappa值分别为0.96、0.87、 0.89、0.87和0.94，两种方法的一致性较 佳（Kappa>0.75）。128-MSCTA诊断冠心 病敏感度最高的为诊断0级，97.91%；特 异度最高的为1级，99.13%；阳性预测值 最高的为0级，96.91%；阴性预测值最高 为4级，99.55%。结论 128-MSCTA诊断冠 心病和判定冠脉狭窄程度效果同选择性 CAG效果一致，作为创伤性小、安全的冠 心病诊断方式，值得临床采用。

Objective Analyze the value of multi-slice spiral CT（128-MSCTA） and selective coronary arteriography （CAG）in the diagnosis of coronary heart disease. Methods Randomly selected 1640 patients who came to the cardiovascular department of our hospital and meet the conditions of the our study.The1640 patients all accepted both the multi-slice spiral CT and selective coronary angiography.Finally we got 3168 stenosis artery segment and compared the diagnosis of stenosis degree, consistency between 128- MSCTA and CAG and diagnosis accuracy of multi slice spiral CT. Results The number of 128-MSCTA diagnosis of 0 grade,1 grade, 2 grade, 3 grade and 4 grade stenosis were 1152 cases, 396 cases, 564 cases, 564 cases and 492 cases respectively; CAG were 1164 cases,360 cases, 516 cases, 612 cases and 516 cases.Comparison of the two methods had no statistical significance (P>0.05). Two methods diagnosed stenosis of 0 grade, 1 grade, 2 grade, 3grade and 4 grade respectively had consistency, the Kappa values were 0.96, 0.87, 0.89, 0.87 and 0.94, the consistency of two methods is good(Kappa>0.75).The highest sensitivity of Multi slice spiral CT in diagnosis of coronary heart disease was grade 0, 97.91%; the highest specificity is grade 1, 99.13%;the highest positive predictive value is grade 0, 96.91%; the highest negative predictive value is grade 4, 99.55%. Conclusion Multi slice spiral CT in diagnosis of coronary heart disease and in judgement of the degree of coronary artery stenosis have consistency with selective coronary arteriography . 128- MSCTA is a way of little trauma and safety, which is worthy of using.