目的 分析动态心电图(DCG)结 合多排螺旋CT(MSCT)对无症状心肌缺血 (SMI)的诊断价值。方法 选取2016年10 月至2018年10月我院诊治的疑似冠心病 患者120例为研究对象，均行DCG、SMI、 核素心肌灌注显像(MPI)检查，分析其影 像特点，以MPI为金标准(其中SMI 80例纳 入SMI组，有症状心肌缺血40例纳入有症 状组)，评估DCG结合MSCT对SMI的诊断价 值。结果 在DCG检查中，SMI组ST段阵次 改变高于有症状组，而ST段下降幅度、ST 段下降持续时间、心肌缺血阈变异性低于 有症状组(P＜0.05)，两组心肌缺血发作 表现呈昼夜节律，于6:00～12:00h最高， 0:00～6:00最低，组间差异无统计学意义 (P＞0.05)；MSCT冠脉造影显示，SMI组冠 脉狭窄程度、钙化斑块、心肌桥发生率 高于有症状组(P＜0.05)，两组软斑块、 开口异常并狭窄率比较差异无统计学意 义(P＞0.05)；DCG结合MSCT诊断SMI的灵 敏度、特异度、准确度、Kappa值分别为 87.50%、92.50%、89.17%、0.766，均较 单纯DCG、MSCT高(P＜0.05)。结论 DCG 结合MSCT对SMI有较高诊断价值，尤其是 MSCT冠状动脉成像能检出SMI冠状动脉异 常改变，值得在临床推广实践。

Objective To analyze the diagnostic value of dynamic electrocardiogram (DCG) combined with multi-slice spiral CT (MSCT) for silent myocardial ischemia (SMI). Methods A total of 120 patients with suspected coronary heart disease and treated in our hospital from October 2016 to October 2018 were selected. All were given DCG, SMI and myocardial perfusion imaging (MPI) examination. The image features were analyzed. Taking MPI as the gold standard (80 patients with SMI in the SMI group, 40 patients with symptomatic myocardial ischemia in the symptomatic group), the diagnostic value of DCG combined with MSCT for SMI was evaluated. Results In the DCG examination, the array time change of ST segment in the SMI group were higher than those in the symptomatic group, while the ST segment decline range, the ST segment decline duration and the variability of myocardial ischemic threshold were lower than the symptomatic group (P<0.05). The onset performance of myocardial ischemic in the two groups was highest at 6:00 to 12:00h and lowest at 0:00 to 6:00. There was no significant difference between the two groups (P>0.05). MSCT coronary angiography showed that the degree of coronary artery stenosis, calcification plaque and incidence of myocardial bridge in SMI group were higher than those in the symptomatic group (P<0.05). There was no significant difference between the two groups in soft plaque, rate of opening abnormality combined with stenosis (P>0.05). The diagnosis sensitivity, specificity, accuracy and Kappa values of SMI by DCG combined with MSCT were 87.50%, 92.50%, 89.17%, and 0.766, respectively, which were all higher than those by DCG and MSCT alone (P<0.05). Conclusion DCG combined with MSCT has high diagnostic value for SMI. And MSCT coronary artery imaging helps the detection of abnormal changes of SMI coronary artery.