中国循环杂志
中國循環雜誌
중국순배잡지
Chinese Circulation Journal
2015年
10期
946-949
,共4页
李卫虹%李昭屏%徐伟仙%马晓伟%冯新恒
李衛虹%李昭屏%徐偉仙%馬曉偉%馮新恆
리위홍%리소병%서위선%마효위%풍신항
冠状动脉血流储备%经胸多普勒超声心动图%三磷酸腺苷负荷试验%高血压%冠状动脉狭窄
冠狀動脈血流儲備%經胸多普勒超聲心動圖%三燐痠腺苷負荷試驗%高血壓%冠狀動脈狹窄
관상동맥혈류저비%경흉다보륵초성심동도%삼린산선감부하시험%고혈압%관상동맥협착
Coronary lfow reserve%Transthoracic Doppler echocardiography%ATP stress echocardiography%Hypertension%Coronary stenosis
目的：探讨经胸多普勒超声心动图（TTDE）检测冠状动脉血流储备（CFR）对高血压患者冠状动脉狭窄的预测价值。<br> 方法：选择132例因胸痛拟行冠状动脉造影（CAG）的患者，根据是否有高血压分为高血压组（n=95）及非高血压组（n=37）。在CAG前2天内行TTDE-三磷酸腺苷（ATP）负荷试验检测冠状动脉左前降支（LAD）的CFR，并比较高血压组及非高血压组的CFR，根据CAG结果，采用受试者工作特征（ROC）曲线分析全部患者及高血压组、非高血压组CFR诊断LAD狭窄≥70％的价值。<br> 结果：非高血压组与高血压组的LAD狭窄≥70％的患者比例组间比较差异无统计学意义（42.1％ vs 35.1%， P>0.05）；而高血压组的 CFR较非高血压组降低[2.39±0.86 vs 2.87±1.12，P<0.05]，差异有统计学意义。CFR诊断LAD狭窄≥70%的ROC曲线下面积在全部患者、高血压组及非高血压组分别为0.884[95％可信区间（CI）：0.83~0.94， P<0.0001]、0.874（95％CI：0.81~0.94，P<0.0001）、0.915（95％CI：0.82~0.98，P<0.0001）。以CFR≤2.20为截点，对全部患者的诊断敏感性为80.3%，特异性为83.5%，准确性为80.3%。对高血压组患者的诊断敏感性为77.5％，特异性为80.0%，准确性为78.9%；非高血压组患者的诊断敏感性为69.2％，特异性为91.7%，准确性为83.8%。<br> 结论：有胸痛症状的高血压患者CFR较非高血压患者降低，提示存在微循环功能异常，对这些患者用CFR预测有意义的LAD狭窄具有较好的诊断价值。
目的：探討經胸多普勒超聲心動圖（TTDE）檢測冠狀動脈血流儲備（CFR）對高血壓患者冠狀動脈狹窄的預測價值。<br> 方法：選擇132例因胸痛擬行冠狀動脈造影（CAG）的患者，根據是否有高血壓分為高血壓組（n=95）及非高血壓組（n=37）。在CAG前2天內行TTDE-三燐痠腺苷（ATP）負荷試驗檢測冠狀動脈左前降支（LAD）的CFR，併比較高血壓組及非高血壓組的CFR，根據CAG結果，採用受試者工作特徵（ROC）麯線分析全部患者及高血壓組、非高血壓組CFR診斷LAD狹窄≥70％的價值。<br> 結果：非高血壓組與高血壓組的LAD狹窄≥70％的患者比例組間比較差異無統計學意義（42.1％ vs 35.1%， P>0.05）；而高血壓組的 CFR較非高血壓組降低[2.39±0.86 vs 2.87±1.12，P<0.05]，差異有統計學意義。CFR診斷LAD狹窄≥70%的ROC麯線下麵積在全部患者、高血壓組及非高血壓組分彆為0.884[95％可信區間（CI）：0.83~0.94， P<0.0001]、0.874（95％CI：0.81~0.94，P<0.0001）、0.915（95％CI：0.82~0.98，P<0.0001）。以CFR≤2.20為截點，對全部患者的診斷敏感性為80.3%，特異性為83.5%，準確性為80.3%。對高血壓組患者的診斷敏感性為77.5％，特異性為80.0%，準確性為78.9%；非高血壓組患者的診斷敏感性為69.2％，特異性為91.7%，準確性為83.8%。<br> 結論：有胸痛癥狀的高血壓患者CFR較非高血壓患者降低，提示存在微循環功能異常，對這些患者用CFR預測有意義的LAD狹窄具有較好的診斷價值。
목적：탐토경흉다보륵초성심동도（TTDE）검측관상동맥혈류저비（CFR）대고혈압환자관상동맥협착적예측개치。<br> 방법：선택132례인흉통의행관상동맥조영（CAG）적환자，근거시부유고혈압분위고혈압조（n=95）급비고혈압조（n=37）。재CAG전2천내행TTDE-삼린산선감（ATP）부하시험검측관상동맥좌전강지（LAD）적CFR，병비교고혈압조급비고혈압조적CFR，근거CAG결과，채용수시자공작특정（ROC）곡선분석전부환자급고혈압조、비고혈압조CFR진단LAD협착≥70％적개치。<br> 결과：비고혈압조여고혈압조적LAD협착≥70％적환자비례조간비교차이무통계학의의（42.1％ vs 35.1%， P>0.05）；이고혈압조적 CFR교비고혈압조강저[2.39±0.86 vs 2.87±1.12，P<0.05]，차이유통계학의의。CFR진단LAD협착≥70%적ROC곡선하면적재전부환자、고혈압조급비고혈압조분별위0.884[95％가신구간（CI）：0.83~0.94， P<0.0001]、0.874（95％CI：0.81~0.94，P<0.0001）、0.915（95％CI：0.82~0.98，P<0.0001）。이CFR≤2.20위절점，대전부환자적진단민감성위80.3%，특이성위83.5%，준학성위80.3%。대고혈압조환자적진단민감성위77.5％，특이성위80.0%，준학성위78.9%；비고혈압조환자적진단민감성위69.2％，특이성위91.7%，준학성위83.8%。<br> 결론：유흉통증상적고혈압환자CFR교비고혈압환자강저，제시존재미순배공능이상，대저사환자용CFR예측유의의적LAD협착구유교호적진단개치。
Objective: To assess the predictive value of coronary lfow reserve (CFR) for diagnosing coronary stenosis by transthoracic Doppler echocardiography (TTDE) in patients with hypertension. <br> Methods: A total of 132 patients scheduled for elective coronary angiography (CAG) due to chest pain were enrolled. The patients were divided into 2 groups: Hypertension group,n=95 and Non-hypertension group,n=37. The CRF of left anterior descending coronary artery (LAD) was measured by ATP stress TTDE at 2 days before CAG in all patients and the results were compared between 2 groups. ROC curve was conducted to assess CFR value in diagnosing LAD stenosis which was deifned by LAD luminal diameter stenosis ≥ 70% in relevant patients. <br> Results: The condition of LAD stenosis was similar between 2 groups (42.1% vs. 35.1%),P>0.05. The CFR value in Hypertension group was lower than that in Non-hypertension group (2.39 ± 0.86) vs. (2.87 ± 1.12),P<0.05. The ROC curve for diagnosing LAD stenosis in all patients were at 0.884 (95% CI 0.83-0.94,P<0.0001), in Hypertension group at 0.874 (95% CI 0.81-0.94,P<0.0001) and in Non-hypertension group at 0.915 (95% CI 0.82-0.98,P<0.0001). With the cut-off point of CFR ≤ 2.2, it had the diagnostic sensitivity, speciifcity and accuracy in all patients were at 80.3%, 83.5% and 80.3%; in Hypertension group were at 77.5%, 80.0% and 78.9%, in Non-hypertension group were at 69.2, 91.7% and 83.8% respectively. <br> Conclusion: The patients of hypertension combining chest pain had decreased CFR which implied the dysfunction of their microcirculation. CFR had the better diagnostic value for predicting the signiifcant LAD stenosis in such patients.
