目 的 分 析 C T 血 管 造 影 ( C T angiography，CTA)、运动平板实验 (treadmill exercise ECG testing， TET)与动态心电图在诊断无症状心肌 缺血(Silent myocardial ischemia， SMI)中的应用价值。方法 选取2014年1 月-2018年2月我院收治的64例疑似SMI患 者，均行CTA、TET与动态心电图检查， 以冠脉造影(coronary angiogram，CAG) 为“金标准”，比较CTA、TET、动态心 电图及TET联合动态心电图检测准确性、 灵敏度与特异度。结果 CTA检查灵敏度 96.61%(57/59)，特异度100.00%(5/5)， 准确性96.88%(62/64)，Kappa值为0.82； TET检查灵敏度84.75%(50/59)，特异度 100.00%(5/5)，准确性85.94%(55/64)， Kappa值为0.46；动态心电图检查灵敏度 83.05%(49/59)，特异度60.00%(3/5)， 准确性81.25%(52/64)，Kappa值为 0.25；TET联合动态心电图检查灵敏度 89.83%(53/59)，特异度80.00%(4/5)，准 确性89.06%(57/64)，Kappa值为0.48； CTA检查准确性、灵敏度明显高于TET、动 态心电图(P＜0.05)，但与TET联合动态心 电图比较无显著差异(P＞0.05)。结论 相 较于TET、动态心电图，CTA诊断SMI准确 性较高，但TET联合动态心电图检查结果 准确性、灵敏度与CTA相当，CTA可作为补 充检查方式。

Objective To analyze the value of CT angiography (CTA), treadmill exercise ECG testing (TET) and dynamic electrocardiogram in the diagnosis of silent myocardial ischemia (SMI). Methods Sixty-four patients with suspected SMI who were admitted to the hospital from January 2014 to February 2018 were selected. All patients underwent CTA, TET and dynamic electrocardiography. With coronary angiogram (CAG) as the golden standard, the detection accuracy, sensitivity and specificity were compared among CTA, TET, dynamic electrocardiogram and TET combined with dynamic electrocardiogram. Results The sensitivity, specificity, accuracy and Kappa value of CTA were 96.61% (57/59), 100.00% (5/5), 96.88% (62/64) and 0.82, respectively. Those of TET were 84.75% (50/59), 100.00% (5/5), 85.94% (55/64) and 0.46, respectively. Those of dynamic electrocardiogram were 83.05% (49/59), 60.00% (3/5), 81.25% (52/64) and 0.25, respectively. Those of TET combined with dynamic electrocardiogram were 89.83% (53/59), 80.00% (4/5), 89.06% (57/64) and 0.48, respectively. The accuracy and sensitivity of CTA were significantly higher than those of TET and dynamic electrocardiogram (P<0.05), but there was no significant difference, compared with TET combined with electrocardiogram (P>0.05). Conclusion Compared with TET and dynamic electrocardiogram, CTA has higher accuracy in diagnosing SMI, but the accuracy and sensitivity of TET combined with dynamic electrocardiogram are similar to CTA. CTA can be used as a supplementary examination.