CAJ | 학술논문

目的：探讨负荷心肌核素灌注显像与计算机断层摄影（CTA）联合检查对冠状动脉慢血流（CSF）的诊断价值。方法回顾性分析自2008年1月至2014年1月于北京军区总医院心内科以心绞痛就诊，同时接受冠状动脉CTA及负荷心肌核素灌注显像检查，并于1个月内接受冠状动脉造影检查的患者共237例，其中男性159例，女性78例，年龄38~69（52.4±11.3）岁。以冠状动脉造影检查作为CSF诊断“金标准”，与冠状动脉CTA和负荷心肌核素灌注显像联合检查比较，评价联合检查对CSF的诊断价值。结果联合检查诊断CSF，其灵敏度为65.6%，特异度为97.1%，漏诊率为34.4%，误诊率为2.9%，总符合率为92.8%。其阳性似然比为22.62，阴性似然比为0.35；阳性预测值为77.8%，阴性预测值为94.8%。采用Kappa检验对两种诊断方法一致性进行检验，Kappa值为0.67，P＜0.001，一致性较好。结论对于CSF患者，负荷心肌核素灌注显像与冠状动脉CTA联合检查具有较高的诊断价值，为临床诊断CSF提供了较为可靠的无创检查手段。
목적：탐토부하심기핵소관주현상여계산궤단층섭영（CTA）연합검사대관상동맥만혈류（CSF）적진단개치。방법회고성분석자2008년1월지2014년1월우북경군구총의원심내과이심교통취진，동시접수관상동맥CTA급부하심기핵소관주현상검사，병우1개월내접수관상동맥조영검사적환자공237례，기중남성159례，녀성78례，년령38~69（52.4±11.3）세。이관상동맥조영검사작위CSF진단“금표준”，여관상동맥CTA화부하심기핵소관주현상연합검사비교，평개연합검사대CSF적진단개치。결과연합검사진단CSF，기령민도위65.6%，특이도위97.1%，루진솔위34.4%，오진솔위2.9%，총부합솔위92.8%。기양성사연비위22.62，음성사연비위0.35；양성예측치위77.8%，음성예측치위94.8%。채용Kappa검험대량충진단방법일치성진행검험，Kappa치위0.67，P＜0.001，일치성교호。결론대우CSF환자，부하심기핵소관주현상여관상동맥CTA연합검사구유교고적진단개치，위림상진단CSF제공료교위가고적무창검사수단。
Objective To discuss the diagnostic value of load myocardial nuclein perfusion imaging combining coronary computed tomographic angiography (CTA) to coronary slow flow (CSF). Methods The patients (n=237, male 159, female 78, aged from 38 to 69 and average age=52.4±11.3) with angina pectoris undergone joint examinations of CTA combining load myocardial nuclein perfusion imaging and meanwhile coronary angiography (CAG) within a month were retrospectively analyzed from Jan. 2008 to Jan. 2014. Taking CAG as a golden standard of CSF diagnosis, and comparing it with the joint examination of load myocardial nuclein perfusion imaging combining CTA, the diagnostic value of the joint examination to CSF was reviewed. Results The sensitivity of the joint examination in diagnosing CSF was 65.6%, specificity, 97.1%, omission diagnostic rate, 34.4%, misdiagnosis rate, 2.9%, total coincidence rate, 92.8%, positive likelihood ratio (PLR), 22.62, negative likelihood ratio (NLR), 0.35, positive predictive value, 77.8%, and negative predictive value, 94.8%. The consistency of 2 diagnostic methods was tested by using Kappa test and the result showed that Kappa value was 0.67 (P<0.001, consistency being higher). Conclusion The joint examination of load myocardial nuclein perfusion imaging combining CTA has higher diagnostic value in CSF patients, which provides a reliable non-invasive examination approach for diagnosing CSF in clinic.