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冠脉造影与双源冠脉CTA在诊断冠脉狭窄程度的价值研究*

作者:郭长磊

所属单位:新乡医学院第一附属医院心内一科(河南 新乡 453100)

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摘要

目的 研究选择性冠脉造影(CAG) 与双源CT冠脉造影(CTA)在诊断冠脉狭窄 程度的临床价值。方法 回顾性分析我 院收治的150例拟诊断为冠脉动脉病变 患者的临床资料,所有患者均先后接受 双源冠脉CTA检查、CAG检查。以CAG结 果为金标准,评价双源冠脉CTA筛查冠 状动脉狭窄的灵敏度、特异度、阳(阴) 性预测值和Kappa值(一致性)。结果 双 源CTA诊断冠脉狭窄的灵敏度为0.986, 特异度为0.750,准确度为0.967,阳性 预测值为0.978,阴性预测值为0.818, Kappa值为0.765,双源CTA与CAG具有较 好的一致性;以CAG为金标准,双源CTA诊 断轻、中、重度管腔狭窄的灵敏度分别 为0.985、0.971、0.969。结论 双源冠 脉CTA诊断冠状动脉异常狭窄的准确性较 高,与CAG筛查结果相近,是一种安全、 可靠的无创诊断方法。

Objective To study the clinical value of selective coronary angiography (CAG) and dual-source CT coronary angiography (CTA) in the diagnosis of coronary artery stenosis. Methods The clinical data of 150 patients with coronary artery disease who were diagnosed in our hospital were analyzed retrospectively. All patients were given dualsource coronary CTA and CAG respectively. The CAG results were used as the gold standard to evaluate the sensitivity, specificity, positive (negative) predictive value and Kappa value (consistency) of dual-source coronary CTA in the screening of abnormal coronary artery stenosis. Results The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of dual-source CTA in the diagnosis of coronary artery stenosis were 0.986, 0.750, 0.967, 0.978, 0.818 and 0.765, and the dualsource CTA and CAG were in good consistency. The sensitivities of dual-source CTA in the diagnosis of mild, moderate, and severe luminal stenosis were 0.985, 0.971 and 0.969, respectively. Conclusion Dual-source coronary CTA has a high accuracy in the diagnosis of abnormal coronary artery stenosis, and it is similar to the results of CAG screening, and it is a safe and reliable non-invasive diagnostic method.

【关键词】选择性冠脉造影;双源CT冠脉 造影;冠脉狭窄程度

【中图分类号】R54;R81

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.02.004

前言

冠状动脉疾病为常见病、多发病,且近年来发病率呈持续上升趋 势,严重威胁人类的身心健康[1]。目前临床多采用选择性冠状动脉造影 (CAG)进行诊疗,该手段可直接判断管腔狭窄程度,也被公认为是诊断 冠状动脉病变的金标准,但其依然具有创伤性、可重复性差、费用昂 贵等缺点,临床应用受限[2]。双源CT扫描因其强大的图像处理技术、快 速的扫描速度以及相对较少的放射辐射,逐渐被运用于冠心病的临床 诊断中,且取得满意的效果,且为无创检查[3]。国内外众多学者认为, 双源CT冠脉造影(CTA)对于冠状动脉自身病变有着较高的灵敏度与特异 度,可作为冠脉病变筛查、诊断的无创性检查方式[4-6]。本研究回顾性 分析我院收治的150例拟诊断为冠脉动脉病变患者的临床资料,分析双 源CTA评价冠脉狭窄的临床价值,并以CAG结果为金标准对比,具体报 告如下。