平板运动试验对冠心病的诊断价值
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摘要
目的：通过以冠脉造影(CAG)为对照,评价平板运动试验(TET)对冠心病的诊断价值。
材料与方法：随机选取50例可疑冠心病患者进行平板运动试验及冠脉造影结果分析。
结果：
1.50例患者中平板运动试验阳性33例,冠脉造影结果阳性22例；平板运动试验阴性17例,冠脉造影结果阳性5例。通过与CAG检查结果对比,分析TET检出冠心病的灵敏性为81.5%(22／27)、特异性为52.2%(12／23)、准确度为68%(34／50)。2.性别差异：灵敏性：男性83.3%、女性77.8%;特异性：男性44.4%、女性57.1%;阳性预测值：男性75%、女性53.8%;阴性预测值：男性57.1%、女性80%;准确性：男性70.4%、女性65.2%。女性的假阳性率明显高于男性(P<0.05)
结论：
1.平板运动试验是一种操作简单、安全、无创、经济的冠心病诊断辅助方法。
2.平板运动试验有较高的敏感性和准确度,能够较准确地评估已明确冠心病的严重程度及判断患者治疗效果及预后。
Purpose:To compare the treadmill exercise test (TET) results with coronary angiography, and to evaluate the diagnostic value of treadmill exercise test in coronary heart disease.
Material and method:
Randomly select 50 cases which were coronary heart disease suspeeively, and analyze the TET results compare with CAG images.
Results:
1.33 patients were positive in treadmill exercise test among 50 subjects.22 patients were positive, while 11 patients were negative in coronary angiography among the 33 positive patients in treadmill exercise test. There were 17 negative patients in treadmill exercise test with 5 positive and 12 negative patients in coronary angiography. The sensitivity, specificity and accuracy were 81.5%(22/27),52.2%(12/23),68%(34/50).
2.Gender differences:The sensitivity, specificity and accuracy in male were 83.3%,44.4%, 70.4%. However, the sensitivity, specificity and accuracy in female were 77.8%,57.1%,65.2%.The false positive rate in female was higher than that in male(P<0.05).
Conclusion:
1. The Treadmill Exercise Test is a simply operated, safe, noninvasive and economic method of auxiliary diagnosis Coronary Heart Disease.
2. The Treadmill Exercise Test has a higher sensitivity and accuracy, can accurately evaluate the severity of already clear Coronary Heart Disease patients and judgment cure effect and prognosis.
材料与方法：随机选取50例可疑冠心病患者进行平板运动试验及冠脉造影结果分析。
结果：
1.50例患者中平板运动试验阳性33例,冠脉造影结果阳性22例；平板运动试验阴性17例,冠脉造影结果阳性5例。通过与CAG检查结果对比,分析TET检出冠心病的灵敏性为81.5%(22／27)、特异性为52.2%(12／23)、准确度为68%(34／50)。2.性别差异：灵敏性：男性83.3%、女性77.8%;特异性：男性44.4%、女性57.1%;阳性预测值：男性75%、女性53.8%;阴性预测值：男性57.1%、女性80%;准确性：男性70.4%、女性65.2%。女性的假阳性率明显高于男性(P<0.05)
结论：
1.平板运动试验是一种操作简单、安全、无创、经济的冠心病诊断辅助方法。
2.平板运动试验有较高的敏感性和准确度,能够较准确地评估已明确冠心病的严重程度及判断患者治疗效果及预后。
Purpose:To compare the treadmill exercise test (TET) results with coronary angiography, and to evaluate the diagnostic value of treadmill exercise test in coronary heart disease.
Material and method:
Randomly select 50 cases which were coronary heart disease suspeeively, and analyze the TET results compare with CAG images.
Results:
1.33 patients were positive in treadmill exercise test among 50 subjects.22 patients were positive, while 11 patients were negative in coronary angiography among the 33 positive patients in treadmill exercise test. There were 17 negative patients in treadmill exercise test with 5 positive and 12 negative patients in coronary angiography. The sensitivity, specificity and accuracy were 81.5%(22/27),52.2%(12/23),68%(34/50).
2.Gender differences:The sensitivity, specificity and accuracy in male were 83.3%,44.4%, 70.4%. However, the sensitivity, specificity and accuracy in female were 77.8%,57.1%,65.2%.The false positive rate in female was higher than that in male(P<0.05).
Conclusion:
1. The Treadmill Exercise Test is a simply operated, safe, noninvasive and economic method of auxiliary diagnosis Coronary Heart Disease.
2. The Treadmill Exercise Test has a higher sensitivity and accuracy, can accurately evaluate the severity of already clear Coronary Heart Disease patients and judgment cure effect and prognosis.
引文
[1]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,多重心血管病危险综合防治建议[J].中华心血管病杂志,2006,34(12)：1061-1071
[2]马秀杰,马寄晓.临床核医学[M].北京：中国协和医科大学、北京医科大学联合出版社,1993.50-165
[3]Hoekstra J, Cohen M. Management of patients with unstable angina/non—ST-elevation myocardial infarction:a critical review of the 2007 ACC/AHA guidelines[J]. Int J Clin Pract.2009 Feb 13. [Epub ahead of print].
[4]陈在嘉,高润霖.冠心病[M].北京：人民卫生出版社,2002,80-85.
[5]Wittlinger T, Voigtlander T, Meyer J, et al. Possibilities and prospects ofnoninvasive bypass diagnosis. Comparison of diferent nuclear magnetic resonance tomography methods with conventional coronary angiography[J]. Med Klin,2002,15,97(4):209-215.
[6]Detrano R, Gianrossi R, Froelieher V. The diagnostic accuracy of the exercise electrocardiog ram:a meta—analysis of 22 years of research. Prog Cardiovase Dis,1989, 32:173.
[7]邵爱菊.平板运动试验心率恢复环在冠心病诊断中应用价值[J].实用心电学杂志,2003,12(2)：93-94
[8]RA Bruce. Methods of exercise testing. Step test, bicycle,t readmilll, isometrics [J]. Am J Cardiol,1974,33 (6):715-720.
[9]Defilippi CR, Rosnnio S,Tscchi M,rl al, Randomized comparison of a srraregy of predischarge cotonary angingraphy versus exercise testing in low risk patients in a chesl pain unit:in-hospital and long-llenn outcomes [J],JACC,2001,37(8);2042-2049.
[10]陈在嘉,高润霖.冠心病[M].北京：人民卫生出版社,2002.251-256.
[11]ACC/AHA 2002 guideline update for exercise testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). JACC,2002,39(3):542—553.
[12]侯翠红,方丕华.平板运动试验在冠心病诊断中的进展.中国医刊,2006.(41)：1
[13]Myers J,Prakaah M,Fmelieher V,et al Exercise capacity and mortality among men referreJ for exercise testing N Eng J Med,2005,353(11):793-801.
[14]陶明.活动平板试验对冠心病诊断价值的研究.复旦大学,硕士学位论文.2008.
[15]陈建平.平板运动试验不同标准诊断冠心病的价值.浙江大学,硕士学位论文.2008,3.
[16]耿强等.平板运动试验在冠心病诊断及预后评价方面的研究进展.心血管病学进展.2009.(、30)2：331.
[17]活动平板运动试验阳性与冠状动脉造影对比研究.青岛大学,硕士学位论文.2004.
[18]Pilhall M, Riha M, Jern S. Ischaemic heart disease and the changes in the QRS and ST segments during exercise:a pilo study with a novel vectorcardiographic system. ClinPhysiol,1992,12:209-23.
[19]Van Campen CM, Visser FC,Visser CA. The QRS score:a promising new exercise score for detecting coronary artery disease based on exercise-induced changes of Q-, R- and S-waves:a relationship with myocardial ischaemia. Eur Heart,1996,17:699-708.
[20]J Myers J,Prakaah M,Fmelieher V,et al Exercise capacity and mortality among men referreJ for exercise testing N Fngl J Med,2005,353(11):793-801.
[21]方不华,卢国英.心电图运动试验[A].见杨跃进,华伟,高润霖.阜外心血管内科手册[M]北京：人民卫生出版社,2006：22-34.
[22]潘晓杰,杨廷宗,林春燕,等.影响平板运动试验诊断冠心病准确性因素分析[J].临床心电学杂志,2007,12(2).96-98.
[23]毛焕元,杨心田.心脏病学.第3版.北京；人民卫生出版社,1995.142-150.
[24]孔明宪,高海青.心血管疾病诊疗技术[M].北京：人民卫生出版社,2001：322.
[25]潘明.运动试验的临床新进展[J].临床心电杂志,2005,14(4)：285.
[26]周静,心电图活动平板运动试验与冠脉造影的对照分析,咸宁学院学报(医学版),1008-0635(2009)03-0245-02
[27]Morise AP, Diamond GA, Detrano R, ef al. Incremental value of exercise electro-cardiography and thallium-201 testing in men and women for the presenceand extent of coronary artery disease[J]. Am Heart J,1995,130(2):267-276.
[28]陈在嘉.临床冠心病学[M].第1版.北京：人民军医出版社,1994：106113.
[29]王海霞,周素敏,王筱梅,等.冠脉造影对平板运动实验诊断冠心病价值的评估.[J].中国误诊学杂志,2003,3(8)：1187 1189.
[30]Kalashnikov Vlu, Mitriagina SN, Syrkin AL, et al. Cost-effect clinical analysis in choice of methods of coronary heart disease diagnosis[J]. Ter Arkh.2008; 80(4): 8.11.Russian.
[31]马秀杰,马寄晓临床核医学[M].北京：巾闰协和医科大学,北京医科大学联合I”版社,1993,50—165
[32]卢喜烈,石亚君运动平板试验[M]. 天津：天津科学技术m版社,2004,22-26
[2]马秀杰,马寄晓.临床核医学[M].北京：中国协和医科大学、北京医科大学联合出版社,1993.50-165
[3]Hoekstra J, Cohen M. Management of patients with unstable angina/non—ST-elevation myocardial infarction:a critical review of the 2007 ACC/AHA guidelines[J]. Int J Clin Pract.2009 Feb 13. [Epub ahead of print].
[4]陈在嘉,高润霖.冠心病[M].北京：人民卫生出版社,2002,80-85.
[5]Wittlinger T, Voigtlander T, Meyer J, et al. Possibilities and prospects ofnoninvasive bypass diagnosis. Comparison of diferent nuclear magnetic resonance tomography methods with conventional coronary angiography[J]. Med Klin,2002,15,97(4):209-215.
[6]Detrano R, Gianrossi R, Froelieher V. The diagnostic accuracy of the exercise electrocardiog ram:a meta—analysis of 22 years of research. Prog Cardiovase Dis,1989, 32:173.
[7]邵爱菊.平板运动试验心率恢复环在冠心病诊断中应用价值[J].实用心电学杂志,2003,12(2)：93-94
[8]RA Bruce. Methods of exercise testing. Step test, bicycle,t readmilll, isometrics [J]. Am J Cardiol,1974,33 (6):715-720.
[9]Defilippi CR, Rosnnio S,Tscchi M,rl al, Randomized comparison of a srraregy of predischarge cotonary angingraphy versus exercise testing in low risk patients in a chesl pain unit:in-hospital and long-llenn outcomes [J],JACC,2001,37(8);2042-2049.
[10]陈在嘉,高润霖.冠心病[M].北京：人民卫生出版社,2002.251-256.
[11]ACC/AHA 2002 guideline update for exercise testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). JACC,2002,39(3):542—553.
[12]侯翠红,方丕华.平板运动试验在冠心病诊断中的进展.中国医刊,2006.(41)：1
[13]Myers J,Prakaah M,Fmelieher V,et al Exercise capacity and mortality among men referreJ for exercise testing N Eng J Med,2005,353(11):793-801.
[14]陶明.活动平板试验对冠心病诊断价值的研究.复旦大学,硕士学位论文.2008.
[15]陈建平.平板运动试验不同标准诊断冠心病的价值.浙江大学,硕士学位论文.2008,3.
[16]耿强等.平板运动试验在冠心病诊断及预后评价方面的研究进展.心血管病学进展.2009.(、30)2：331.
[17]活动平板运动试验阳性与冠状动脉造影对比研究.青岛大学,硕士学位论文.2004.
[18]Pilhall M, Riha M, Jern S. Ischaemic heart disease and the changes in the QRS and ST segments during exercise:a pilo study with a novel vectorcardiographic system. ClinPhysiol,1992,12:209-23.
[19]Van Campen CM, Visser FC,Visser CA. The QRS score:a promising new exercise score for detecting coronary artery disease based on exercise-induced changes of Q-, R- and S-waves:a relationship with myocardial ischaemia. Eur Heart,1996,17:699-708.
[20]J Myers J,Prakaah M,Fmelieher V,et al Exercise capacity and mortality among men referreJ for exercise testing N Fngl J Med,2005,353(11):793-801.
[21]方不华,卢国英.心电图运动试验[A].见杨跃进,华伟,高润霖.阜外心血管内科手册[M]北京：人民卫生出版社,2006：22-34.
[22]潘晓杰,杨廷宗,林春燕,等.影响平板运动试验诊断冠心病准确性因素分析[J].临床心电学杂志,2007,12(2).96-98.
[23]毛焕元,杨心田.心脏病学.第3版.北京；人民卫生出版社,1995.142-150.
[24]孔明宪,高海青.心血管疾病诊疗技术[M].北京：人民卫生出版社,2001：322.
[25]潘明.运动试验的临床新进展[J].临床心电杂志,2005,14(4)：285.
[26]周静,心电图活动平板运动试验与冠脉造影的对照分析,咸宁学院学报(医学版),1008-0635(2009)03-0245-02
[27]Morise AP, Diamond GA, Detrano R, ef al. Incremental value of exercise electro-cardiography and thallium-201 testing in men and women for the presenceand extent of coronary artery disease[J]. Am Heart J,1995,130(2):267-276.
[28]陈在嘉.临床冠心病学[M].第1版.北京：人民军医出版社,1994：106113.
[29]王海霞,周素敏,王筱梅,等.冠脉造影对平板运动实验诊断冠心病价值的评估.[J].中国误诊学杂志,2003,3(8)：1187 1189.
[30]Kalashnikov Vlu, Mitriagina SN, Syrkin AL, et al. Cost-effect clinical analysis in choice of methods of coronary heart disease diagnosis[J]. Ter Arkh.2008; 80(4): 8.11.Russian.
[31]马秀杰,马寄晓临床核医学[M].北京：巾闰协和医科大学,北京医科大学联合I”版社,1993,50—165
[32]卢喜烈,石亚君运动平板试验[M]. 天津：天津科学技术m版社,2004,22-26