临床表现结合危险因素对不同种族老年及中青年女性冠心病诊断准确性的价值

摘要

Objective To investigate the role of clinical presentation combined with risk factors in diagnosis of coronary heart disease (CHD) in elderly or non-elderly women of different races. Methods 2395 female patients who underwent coronary angiography(CAG) were divided into 4 groups according to race (yellow or white) and age( <60 or ≥ 60). Then the values of clinical presentation combined with major risk factors(hypertension, hyperlipemia and diabetes) for clinical diagnosis were identified. Results (1 )The incidences of unstable angina pectoris( UA) and atypical symp-toms(AS) were significantly higher in yellow women than those in white (31.3% vs 17. 1% and 40.0% vs 26.2% , 62.9% vs 22. 8% and 51.0% vs 15.9% , P <0.01). The incidence of stable angina pectoris( SA) was significantly lower, in yellow women than that in white(5.8% vs 60. 1% and 8. 9% vs57.9%, P<0.01). (2) The diagnostic accuracy of angina pectoris (AP) in yellow women was significantly higher than that of AS, regardless of the age and the number of the risk factors. (3) The diagnostic accuracy of angina pectoris( AP) in white women was also significantly higher than that of AS,regardless of the age and the number of the risk factors. Conclusions The diagnosis is more accurate in aged women with symptom of AP complicated with diabetes, hypertension and hyperlipemia. AP has positive predictive value in yellow women while AS has negative predictive value in white women.%目的 探讨临床表现结合危险因素对不同种族老年及中青年女性诊断冠心病准确性的价值.方法 2395例接受冠状动脉造影(CAG)检查的女性按种族(黄种人和白种人)和年龄(＜60岁和≥60岁)分为4组.分析临床表现结合冠心病主要危险因素(高血压、高血脂、糖尿病)对临床诊断准确率的影响. 结果 (1)黄种女性老年组及非老年组不典型胸痛的发生率均显著高于同龄白人女性(62.9％比22.8％,51.0％比15.9％,P＜0.01),稳定型心绞痛(SA)的发生率显著低于同龄白人女性(5.8％比60.1％,8.9％比57.9％,P＜0.01).(2)黄种人女性诊断为心绞痛时,与CAG的符合率显著高于不典型胸痛患者,诊断符合率在＜60岁组随着危险因素从0,1,2逐渐增多,分别为63.2％比18.1％,87.8％比32.9％,88.2％比42.3％,在老年组分别为76.1％比35.0％,83.8％比59.3％,85.4％比72.6％.(3)白人女性诊断为心绞痛时,与CAG的符合率也高于不典型胸痛患者.在＜60岁组伴1～2个危险因素时诊断符合率分别为63.8％比32.3％,78.9％比33.3％ (P＜0.01),在老年组伴有0,1,2个危险因素时诊断符合率分别为65.3％比27.3％,74.2％比48.7％,76.9％比46.9％(P＜0.01). 结论 在老年女性,有心绞痛症状,伴有糖尿病、高血压及高血脂危险因素时诊断准确率高.心绞痛症状对黄种人女性冠心病的阳性预测价值大,不典型症状对白人女性冠心病的阴性预测价值大.