目 的 分析24h动态心电图 (Holter)联合64排螺旋电子计算机断层 扫描(MDCT)冠状动脉成像诊断隐匿性冠 心病(CHD)的准确性。方法 选取我院68 例疑似隐匿性CHD患者为研究对象，对患 者分别行24h Holter、64 MDCT冠状动脉 成像及冠状动脉造影(CAG)检查，以CAG 为诊断隐匿性CHD金标准，分析比较24h Holter、64 MDCT冠状动脉成像及其联合 诊断对隐匿性CHD的诊断价值。结果 共68 例患者中60例确诊为隐匿性CHD，其481段 冠状动脉中冠状动脉管腔正常264段，轻 度病变124段，中度病变67段，重度病变 26段。64 MDCT冠状动脉成像诊断准确60 例(88.24%)，且对冠状动脉管腔狭窄程度 诊断准确187段(86.18%)；24h Holter诊 断准确55例(80.88%)；联合诊断诊断准确 66例(97.06%)。联合诊断的灵敏度明显高 于24h Holter(P＜0.05)，准确率明显高 于64 MDCT冠状动脉成像及24h Holter(P ＜0.05)；而64 MDCT冠状动脉成像及24h Holter灵敏度、准确率和3种诊断方式的 特异度、阳性预测值、阴性预测值比较， 差异均无统计学意义(P＞0.05)。结论 24h Holter、64 MDCT冠状动脉成像联合 可提高隐匿性CHD的诊断准确性，具有较 好的应用前景。

Objective To analyze the accuracy of 24h dynamic electrocardiogram (Holter) combined with 64-slice spiral computed tomography (MDCT) coronary angiography in the diagnosis of latent coronary heart disease (CHD). Methods A total of 68 cases of suspected latent CHD in our hospital were selected for the study, and the patients were given 24h Holter, 64 MDCT coronary angiography and coronary angiography (CAG). Take CAG was the gold standard for the diagnosis of latent CHD, and the diagnostic values of 24h Holter, 64 MDCT coronary angiography and the combined diagnosis for latent CHD were analyzed and compared. Results Of the 68 patients, 60 cases were diagnosed as latent CHD. Among the 481 coronary arteries, 264 were normal coronary lumens, 124 were mild lesions, 67 were moderate lesions, and 26 were severe lesions. 64 MDCT coronary angiography was accurate in 60 cases (88.24%), and the diagnosis of coronary stenosis was accurate in 187 segments (86.18%). 24h Holter was accurate in 55 cases (80.88%), and the combined diagnosis was accurate in 66 cases (97.06%). The sensitivity of combined diagnosis was significantly higher than that of 24h Holter (P<0.05), and the accuracy was significantly higher than that of 64 MDCT coronary angiography and 24h Holter (P<0.05). There were no significant differences in the sensitivity and accuracy between 64 MDCT coronary angiography and 24h Holter and in the specificity, positive predictive value and negative predictive value among the three diagnostic methods (P>0.05). Conclusion 24h Holter combined with 64 MDCT coronary angiography can improve the diagnostic accuracy of latent CHD, and has a good application prospect.