64-SCTCA诊断冠心病疑似患者的准确性分析

摘要

Objective To explore the diagnostic accuracy and influence factors of 64-slice computed tomogra-phy coronary angiography (64-SCTCA) in patients with suspected coronary artery disease (CAD). Methods Eighty patients with suspected coronary artery disease who examined by 64-SCTCA was analyzed. The patients were divided into three groups according to Duke probability model: low risk group (n=25), intermediate risk group (n=25), high risk group (n=30). The diagnostic accuracy of 64-SCTCA was judged and the influence factors of diagnostic accuracy including coronary artery calcification, different parts of the blood vessel segment were evaluated. Results The pa-tient-based diagnostic accuracy of 64-SCTCA for detecting CAD according to CAG revealed a sensitivity of 82.4%, a specificity of 93.3%, a positive predictive value of 68.4%and a negative predictive value of 96.8%. The sensitivity, positive predictive value and negative predictive value in low risk group were all lower than those in intermediate risk group and high risk group (P<0.05). For those with coronary artery calcium score>400, the diagnostic accuracy was linked with a higher sensitivity (P<0.05) but a lower specificity (P<0.05). The diagnostic value of 64-SCTCA for proximal and mid-segment of coronary artery was superior to that for distal segment (P<0.05). Conclusion 64-SCT-CA is mainly indicated in individuals with an intermediate probability of having CAD. The diagnostic value of 64-SCTCA could be affected by coronary artery calcium, lesion location and vessel diameter.%目的：探讨64层螺旋CT冠状动脉成像(64-SCTCA)对冠心病疑似患者诊断的准确性及其影响因素。方法分析80例接受64-SCTCA检查的冠心病疑似患者的临床资料。将患者依据冠心病概率Duke模型分为低危组(n=25)、中危组(n=25)和高危组(n=30)。以CAG为“金标准”，判断64-SCTCA诊断各组患者的准确性及冠状动脉钙化、不同部位血管节段等因素对诊断准确性的影响。结果64-SCTCA诊断冠心病的敏感性、特异性、阳性预测值和阴性预测值分别为82.4%、93.3%、68.4%、96.8%；低危组的敏感性、阳性预测值和诊断准确指数均明显低于中、高危组(P<0.05)；冠状动脉钙化积分>400组的敏感性明显高于0~100分组和101~400分组(P<0.05)，而特异性明显低于其他两组(P<0.05)；诊断远端血管病变的敏感性、阳性预测值均明显低于近、中段血管(P<0.05)。结论64-SCTCA主要适用于冠心病Duke模型中的中危人群，其诊断准确性受冠状动脉钙化、病变部位、管腔直径等因素影响。