多层螺旋CT冠脉造影对急性冠脉综合征的诊断价值研究
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摘要
目的探讨多层螺旋CT(multi spiral computed tomography, MSCT)冠脉造影对急性冠脉综合征(acute coronary syndrome, ACS)的诊断价值。方法选择2016年6月至2018年6月青岛市胶州中心医院收治的ACS患者400例,均采用Ingenuity CT型64排128层螺旋CT(PHILIPS公司)行MSCT冠脉造影检查,并以数字减影血管造影(digital subtraction angiography, DSA)结果作为ACS诊断的金标准,分析MSCT冠脉造影对ACS的诊断价值。结果在400例患者中,395例出现不同程度的冠脉狭窄,385例MSCT冠脉造影诊断ACS阳性。MSCT冠脉造影诊断ACS的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为98.97%(384/388)、91.67%(11/12)、99.74%(384/385)、73.33%(11/15)、98.75%(395/400),漏诊率为1.03%(4/388),误诊率为8.33%(1/12)。随着ACS危险因素的增多,MSCT冠脉造影诊断ACS的阳性率逐渐增高(P<0.05)。MSCT冠脉造影检出ACS合并轻中度冠脉狭窄或伴2～3个危险因素为主(P<0.05)。结论 MSCT冠脉造影可准确评定冠脉狭窄程度,对ACS具有明显的诊断价值,值得临床应用。
Objective To study the diagnosis value of multi spiral computed tomography(MSCT) coronary angiography for acute coronarysyndrome(ACS). Method 400 cases of patients with ACS during the period of June 2016 to June 2018 were selected as the research object,all patients were given MSCT coronary angiography by IngenuityCT 64 128 layers spiral CT(PHILIPS company), the examination resultof digital subtraction angiography(DSA) were as the gold standard for ACS diagnosis, the diagnosis value of ACS by MSCT coronaryangiography were analyzed. Result All for 400 patients, 395 cases patient had different degree of coronary artery stenosis, 385 cases werepositive for MSCT coronary angiography in the diagnosis of ACS. The sensitivity, speci?city, positive predictive value, negative predictivevalue and accuracy of MSCT coronary angiography in the diagnosis of ACS were 98.97%(384/388), 91.67%(11/12), 99.74%(384/385),73.33%(11/15), 98.75%(395/400), the missed diagnosis rate was 1.03%(4/388), the misdiagnosis rate was 8.33%(1/12). As the increaseof the risk factors for ACS, positive rate of MSCT coronary angiography in the diagnosis of ACS was higher, P<0.05. MSCT coronaryangiography examination found that ACS was given priority to mild-to-moderate coronary stenosis, and was given priority to 2～3 riskfactors(P<0.05). Conclusion Diagnosis value of MSCT coronary angiography for ACS is signi?cant by accurately assessing coronarystenosis, it is worthy of clinical popularization and application.
Objective To study the diagnosis value of multi spiral computed tomography(MSCT) coronary angiography for acute coronarysyndrome(ACS). Method 400 cases of patients with ACS during the period of June 2016 to June 2018 were selected as the research object,all patients were given MSCT coronary angiography by IngenuityCT 64 128 layers spiral CT(PHILIPS company), the examination resultof digital subtraction angiography(DSA) were as the gold standard for ACS diagnosis, the diagnosis value of ACS by MSCT coronaryangiography were analyzed. Result All for 400 patients, 395 cases patient had different degree of coronary artery stenosis, 385 cases werepositive for MSCT coronary angiography in the diagnosis of ACS. The sensitivity, speci?city, positive predictive value, negative predictivevalue and accuracy of MSCT coronary angiography in the diagnosis of ACS were 98.97%(384/388), 91.67%(11/12), 99.74%(384/385),73.33%(11/15), 98.75%(395/400), the missed diagnosis rate was 1.03%(4/388), the misdiagnosis rate was 8.33%(1/12). As the increaseof the risk factors for ACS, positive rate of MSCT coronary angiography in the diagnosis of ACS was higher, P<0.05. MSCT coronaryangiography examination found that ACS was given priority to mild-to-moderate coronary stenosis, and was given priority to 2～3 riskfactors(P<0.05). Conclusion Diagnosis value of MSCT coronary angiography for ACS is signi?cant by accurately assessing coronarystenosis, it is worthy of clinical popularization and application.
引文
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[15]蔡培坤,梁晖辉,董琴.640层螺旋CT结合血脂标志物对糖尿病合并冠心病患者冠脉斑块范围和组成特征的评估[J].功能与分子医学影像学(电子版),2017,6(2):1183-1188.
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[17]张东香,陈伟彬.多层螺旋CT冠状动脉成像对冠脉支架血管再狭窄的诊断价值[J].中国实验诊断学,2016,20(9):1452-1454.
[18]肖冲冲,黄贤胜,丁振江,等.64排螺旋CT冠状动脉成像对冠心病诊断准确性的影响因素分析[J].临床心血管病杂志,2016,32(3):245-250.
[2]汤艳萍,李令建.64排螺旋CT与选择性冠状动脉造影评价急性冠状动脉综合征患者易损斑块形态、成分及大小的价值对比研究[J].临床放射学杂志,2016,35(8):1181-1185.
[3]韩宏程.多排螺旋CT冠脉血管造影在冠心病中的应用研究[J].CT理论与应用研究,2015,24(6):843-848.
[4]高兴法,刘挨师.CT冠状动脉造影对冠状动脉斑块研究的诊断价值[J].中国医药导报,2016,13(4):45-48.
[5]侯新民,胡俊,陈彩美.64排螺旋CT与选择性冠脉造影评价急性冠脉综合征患者易损斑块特征分析[J].实用临床医药杂志,2017,21(24):61-64.
[6]黄晗,刘白鹭.64层螺旋CT评估冠脉狭窄与左心室功能的临床应用研究[J].中国CT和MRI杂志,2016,14(7):44-46.
[7]巢为农,吴晶晶.冠脉造影与动态心电图监测在诊断老年冠心病患者的比较研究[J].中国血液流变学杂志,2015,25(4):433-435.
[8]Rigamonti F,Carbone F,Montecucco F,et al.Serum lipoprotein(a)predicts acute coronary syndromes in patients with severe carotid stenosis[J].Eur J Clin Invest,2018,48(3):45-49.
[9]欧艳勉,伍广伟,王孟杰,等.高血压合并冠心病患者发生急性冠状动脉综合征的危险因素分析[J].医学综述,2016,22(21):4286-4288.
[10]Raphael CE,Heit JA,Reeder GS,et al.Coronary embolus:an underappreciated cause of acute coronary syndromes[J].JACCCardiovasc Interv,2018,11(2):172-180.
[11]姬国敏,王景志.64排螺旋CT冠脉成像与DSA诊断心律不齐临床对比分析[J].影像研究与医学应用,2018,2(6):64-66.
[12]周喆,刘长柱,刘玥,等.MSCT在冠心病诊断及冠心病PCI术后支架内再狭窄的预测价值[J].中国CT和MRI杂志,2018,16(8):74-76.
[13]沈冬元,王强,蒋兆杰,等.64排螺旋CT成像在冠心病诊断中的应用价值分析[J].影像研究与医学应用,2018,2(5):148-150.
[14]李瑞珍.MSCT与SPECT对冠心病诊断的灵敏度及特异性的比较[J].中国医疗器械信息,2017,23(18):95-96.
[15]蔡培坤,梁晖辉,董琴.640层螺旋CT结合血脂标志物对糖尿病合并冠心病患者冠脉斑块范围和组成特征的评估[J].功能与分子医学影像学(电子版),2017,6(2):1183-1188.
[16]张玥.MSCT成像技术在冠脉造影中的应用[J].中西医结合心血管病电子杂志,2016,4(13):83-84.
[17]张东香,陈伟彬.多层螺旋CT冠状动脉成像对冠脉支架血管再狭窄的诊断价值[J].中国实验诊断学,2016,20(9):1452-1454.
[18]肖冲冲,黄贤胜,丁振江,等.64排螺旋CT冠状动脉成像对冠心病诊断准确性的影响因素分析[J].临床心血管病杂志,2016,32(3):245-250.