目的 分析64排螺旋CT冠脉成像 诊断冠心病合并糖尿病的准确性影响因 素。方法 分析我院248例冠心病合并糖 尿病患者的临床资料。将患者按照钙化积 分、平均心率、心率波动及空腹血糖浓度 的不同程度进行分组，以CAG诊断结果为 金标准，计算各组64排螺旋CT冠脉成像 评估冠脉狭窄≥50%敏感度、特异度、阳 性预测值、阴性预测值及诊断符合率并 进行统计学分析。结果 (1)64排螺旋CT 冠脉成像及CAG共同显影及评估的冠脉节 段有2036节段，其中男性1424节段，女 性612节段；(2)以CAG为金标准，64排螺 旋CT冠脉成像诊断轻度钙化组特异度、 阳性预测值及诊断符合率均高于重度钙 化组，经统计学分析，差异具有统计学 意义(P<0.05)；诊断心率分组(心率>70 次/min及心率≤70次/min组)、心率波 动分组(心率波动>15次/min及心率波动 ≤15次/min组)及空腹血糖分组(空腹血糖 >10.00mmol/L及空腹血糖≤10.00mmol/ L组)的敏感度、特异度、阳性预测值、 阴性预测值及诊断符合率均无明显差异 (P>0.05)；诊断男性、女性组的特异度、 阴性预测值及诊断符合率均无明显差异， 诊断女性组灵敏度及阳性预测值低于男性 组，差异具有统计学意义(P<0.05)。结论 严重的冠脉钙化降低64排螺旋CT冠脉成像 的诊断准确性，在高心率及心率波动下64 排螺旋CT冠脉成像仍具有较高的诊断准确 性，诊断女性患者敏感度及阳性预测值低 于男性，空

Objective To analyze the factors affecting the accuracy of 64 row spiral CT coronary artery imaging in the diagnosis of coronary heart disease with diabetes. Methods To retrospectively analyze 248 cases of patients coronary heart disease with diabetes mellitus who underwent 64 row spiral CT coronary artery imaging and coronary angiography (CAG) examination in our hospital. They were divided into groups according to calcification score, the average heart rate, heart rate, fluctuation and fasting plasma glucose concentrations. different level to the CAG diagnosis as the gold standard, each 64 row spiral CT coronary artery imaging evaluation of coronary artery stenosis degree of 50% or higher sensitivity, specific, positive predictive value, negative predictive value and the diagnostic coincidence rate and statistical analysis. Results (1)64 row spiral CT coronary artery imaging and CAG common development, and evaluation of 2036 segmental coronary segments, 1424 segments of men, 612 segment of women, (2) CAG as the gold standard, 64 row spiral CT coronary artery imaging in the diagnosis of mild degree of calcification group specific, positive predictive value and the diagnosis coincidence rate were higher than in severe calcification group, after statistics analysis, the difference statistically significant (P<0.05). Grouping diagnosis of heart rate (heart rate>70 times/min and heart rate of 70 times/min or less) and heart rate fluctuations group (heart rate fluctuations>15 times/min and heart rate group 15 times/min or less) and fasting plasma glucose group (fasting glucose>10.00mmol/L and fasting plasma glucose group≤10.00mmol/L) or less sensitivity, specific, positive predictive value, negative predictive value and diagnostic coincidence rate had no obvious difference (P>0.05). Diagnosis of male and female specific degree, negative predictive value and the diagnosis coincidence rate had no obvious difference, diagnosis of female sensitivity and positive predictive value is lower than the male group, difference has statistical significance (P<0.05). Conclusion Severe coronary calcification reduce the diagnostic accuracy of CT coronary artery imaging. The imaging way still has high diagnostic accuracy even with high heart rate and heart rate fluctuations; Its diagnostic sensitivity and positive predictive value is lower in female than male. The fasting blood glucose has not effect on the diagnostic accuracy.