天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (8): 870-874.doi: 10.11958/20210766

• 应用研究 • 上一篇    下一篇

验前概率联合核素心肌灌注显像对冠心病的诊断价值及性别差异

宋智勇 1，姜超 2，罗东雷 3△，姚艳影 3，张磊 1，刘蕾 3，侯云生 1   

  1. 1中国人民解放军联勤保障部队第九八〇医院急诊科（邮编050000）；2承德医学院；3承德市中心医院，承德医学院第二临床学 院心内科
  • 收稿日期:2021-03-31 修回日期:2021-04-19 出版日期:2021-08-15 发布日期:2021-08-19
  • 通讯作者: 罗东雷 E-mail:1342258345@qq.com
  • 作者简介:宋智勇（1980），男，本科，主治医师，主要从事急诊心血管疾病研究。E-mail：384718902@qq.com
  • 基金资助:
    河北省医学科学研究课题计划（20200236，20200348）

The effect of pre-test probability combined with radionuclide myocardial perfusion imaging on the diagnosis of coronary heart disease in different genders

SONG Zhi-yong1, JIANG Chao2, LUO Dong-lei3△,YAO Yan-ying3, ZHANG Lei1, LIU Lei3, HOU Yun-sheng1   

  1. 1 Department of Emergency, 980 Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050000, China; 2 Chengde Medical University; 3 Department of Cardiology, Chengde Central Hospital, Second Clinical College of Chengde Medical University △Corresponding Author E-mail: luoyutian999@126.com
  • Received:2021-03-31 Revised:2021-04-19 Published:2021-08-15 Online:2021-08-19

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摘要： 目的 分析验前概率（PTP）联合核素心肌灌注显像（MPI）对冠心病（CHD）的诊断价值及性别差异。方 法 选取2019年7月—2020年12月本院接收的270例疑似CHD患者为研究对象，全部患者均计算PTP并进行MPI 检查，初步评估CHD风险，并行冠状动脉造影（CAG）检查；以CAG结果为依据，分析PTP联合MPI技术对CHD及不 同性别CHD患者的诊断价值。结果 270例疑似CHD患者经CAG检查，188例（69.63%）为CHD，其中男110例，女 78例；以CAG检查结果为依据，PTP联合MPI共检出176例CHD患者，总符合率为93.62%，其中男107例，女69例； PTP 联合 MPI 诊断女性 CHD 患者的敏感度为 88.46%、特异度为 88.89%、准确度为 88.60%、阳性预测值为 94.52%、 阴性预测值为78.05%；与CAG结果具有理想一致性（Kappa=0.746）；PTP联合MPI诊断男性患者敏感度为97.27%、 特异度为 95.65%、准确度为 96.79%、阳性预测值为 98.17%、阴性预测值为 93.62%；与 CAG 结果具有极好一致性 （Kappa=0.923）。PTP联合MPI诊断男性CHD的敏感度、准确度、阴性预测值高于女性患者，差异有统计学意义（P＜ 0.05）。结论 PTP联合MPI检查对CHD具有较高诊断价值，且诊断男性CHD患者敏感度、准确度及阴性预测值较 女性高。

关键词: 冠心病, 心肌灌注显像, 性别因素, 敏感性与特异性, 验前概率

Abstract: Objective To analyze the value of pre-test probability (PTP) combined with radionuclide myocardial perfusion imaging (MPI) in the differential diagnosis of coronary heart disease (CHD) in different genders. Methods A total of 270 patients with suspected CHD received by our hospital from July 2019 to December 2020 were prospectively selected as the research subjects. All patients received PTP and MPI, and the risk of CHD was preliminary assessed. The coronary angiography (CAG) was also performed. Based on the results of CAG, the diagnostic value of PTP combined with MPI was analyzed in patients with CHD and CHD patients of different genders. Results Among 270 suspected CHD patients, 188 cases (69.63%) were CHD, including 110 male patients and 78 female patients after CAG examination. Based on the examination results of CAG, 176 patients with CHD were detected by PTP combined with MPI, and the total coincidence rate was 93.62%, of which there were 107 male patients and 69 female patients. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of female patients diagnosed by PTP combined with MPI were 88.46%, 88.89%, 88.60%, 94.52% and 78.05%, respectively, which showed the ideal consistency with the results of CAG (Kappa= 0.746). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of male patients diagnosed by the PTP combined with MPI were 97.27%, 95.65%, 96.79%, 98.17% and 93.62% respectively, which were in good agreement with the results of CAG (Kappa=0.923). The sensitivity, accuracy and negative predictive value of PTP combined with MPI in the diagnosis of CHD were significantly higher in male patients than those of female patients (P＜ 0.05). Conclusion PTP combined with MPI examination has a higher diagnostic value for CHD, and the sensitivity and accuracy are higher in male patients with CHD than those of female patients.

Key words: coronary disease, myocardial perfusion imaging, sex factors, sensitivity and specificity, pre-test probability

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