CAJ | 학술논문

目的：莱文征结合心肌梗死溶栓疗法危险评分（TIMI 危险评分）与单独运用 TIMI 危险评分比较，探讨两种方法在急性胸痛患者筛选急性冠脉综合征（ACS）的临床价值。方法对171例胸痛患者随机分成试验组81例（TIMI 危险评分＋莱文征阳性）与对照组90例（TIMI 危险评分），根据患者的 TIMI 危险评分值，将其分成低分组（0～2分）、中分组（3～4分）与高分组（5～7分），在3个分值段内分别比较单独应用 TIMI 危险评分与 TIMI危险评分联合莱文征阳性对 ACS 发生率的差异性。结果TIMI 危险评分低分组中，用试验组方法13例，3例诊断为 ACS，筛查率为23．08％，用对照组方法11例，2例诊断为 ACS，筛查率为18．18％。两者进行χ2检验，差异无统计学意义（P ＞0．05）；TIMI 危险评分高分组患者中，用试验组方法41例，33例诊断为 ACS，筛查率为80．49％，用对照组方法46例，35例诊断为 ACS，筛查率为76．09％，进行χ2检验，差异无统计学意义（P ＞0．05）；在 TIMI危险评分中分组（3～4分）患者中，用试验组方法27例，20例诊断为 ACS，筛查率为74．07％。用对照组方法33例，17例诊断为 ACS，筛查率为51．52％。两者进行χ2检验，差异有统计学意义（P ＜0．05）。在中分组中，运用TIMI 危险评分联合莱文征与冠脉造影术这一金指标进一步比较后，发现运用 TIMI 危险评分联合莱文征诊断ACS 的敏感性为86．84％，特异性为90．91％，诊断符合率为88．33％（P ＜0．001）。结论TIMI 危险评分结合莱文征后，在中分组急性冠脉综合征的发生率比单独运用 TIMI 危险评分的发生率高，与单独运用 TIMI 危险评分系统相比，可以更好地预测 ACS 的发生，可以作为在急性胸痛患者筛选急性冠脉综合征的一项简单、有效工具。
목적：래문정결합심기경사용전요법위험평분（TIMI 위험평분）여단독운용 TIMI 위험평분비교，탐토량충방법재급성흉통환자사선급성관맥종합정（ACS）적림상개치。방법대171례흉통환자수궤분성시험조81례（TIMI 위험평분＋래문정양성）여대조조90례（TIMI 위험평분），근거환자적 TIMI 위험평분치，장기분성저분조（0～2분）、중분조（3～4분）여고분조（5～7분），재3개분치단내분별비교단독응용 TIMI 위험평분여 TIMI위험평분연합래문정양성대 ACS 발생솔적차이성。결과TIMI 위험평분저분조중，용시험조방법13례，3례진단위 ACS，사사솔위23．08％，용대조조방법11례，2례진단위 ACS，사사솔위18．18％。량자진행χ2검험，차이무통계학의의（P ＞0．05）；TIMI 위험평분고분조환자중，용시험조방법41례，33례진단위 ACS，사사솔위80．49％，용대조조방법46례，35례진단위 ACS，사사솔위76．09％，진행χ2검험，차이무통계학의의（P ＞0．05）；재 TIMI위험평분중분조（3～4분）환자중，용시험조방법27례，20례진단위 ACS，사사솔위74．07％。용대조조방법33례，17례진단위 ACS，사사솔위51．52％。량자진행χ2검험，차이유통계학의의（P ＜0．05）。재중분조중，운용TIMI 위험평분연합래문정여관맥조영술저일금지표진일보비교후，발현운용 TIMI 위험평분연합래문정진단ACS 적민감성위86．84％，특이성위90．91％，진단부합솔위88．33％（P ＜0．001）。결론TIMI 위험평분결합래문정후，재중분조급성관맥종합정적발생솔비단독운용 TIMI 위험평분적발생솔고，여단독운용 TIMI 위험평분계통상비，가이경호지예측 ACS 적발생，가이작위재급성흉통환자사선급성관맥종합정적일항간단、유효공구。
Objective To analyze and compare the clinical effect of using TIMI risk score combined with Levin′s sign with using TIMI risk score only in screening the acute coronary syndrome (ACS)in patients with acute chest pain.Methods 171 patients were randomly divided into experimental group and control group.81 cases were in experimental group (TIMI risk score+Levin′s sign)and 90 cases were in control group (TIMI risk score).The unified questionnaire and statistical information of patients were collected. According to patients′TIMI risk score values,it was graded into low (0~2)group,middle (3~4)group and the high (5~7)group.The main role is to analyze the difference of incidence of ACS by two methods in three groups.Results In the low TIMI risk score group (0~2),experimental methods were used in 13 cases,among whom 3 cases were diagnosed as acute coronary syndrome(23.08%).The control methods were used in 11 cases,among whom 2 cases were diagnosed as acute coronary syndrome (18.18%.Afterχ2 test,there was no statistically significant difference (P >0.05)between two groups.In the middle TIMI risk score group (3~4),experimental methods were used in 27 cases,among whom 20 cases were diag-nosed as acute coronary syndrome(74.07%).The control methods were used in 33 cases,among whom 17 cases were diagnosed with acute coronary syndrome(51.52%).After χ2 test,here was statistical signifi-cance (P <0.05).In the high TIMI risk score group (5~7),the experimental methods were used in 41 ca-ses,among whom 33 cases were diagnosed as acute coronary syndrome (80.49%).The control methods were used in 46 cases,among whom 35 cases were diagnosed as acute coronary syndrome(76.09%),there was no statistically significant difference (P >0.05).In the middle group,the joint TIMI risk score and Levin sign were compared with gold indicators coronary angiography,it was found that the sensitivity of the joint TIMI risk score and Levin sign in the diagnosis of ACS was 86.84%,the specificity was 90.91%, the diagnostic coincidence rate was 88.33% (P <0.001).Conclusion In the middle group,there is higher incidence of acute coronary syndrome if we combine the Levin′s sign with TIMI risk score in evaluating ACS,we will predict the occurrence of ACS more exactly,and it may be a simple and effective tool for ACS screening in patients with acute chest pain.