天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (3): 310-314.doi: 10.11958/20202381

• 应用研究 • 上一篇    下一篇

利用冠状动脉CT血管造影比较NICE与ESC指南的稳定性胸痛危险分层和诊断策略

朱慧洁1，张颖2△，刘玉洁2，周伽2   

  1. 1天津医科大学胸科临床学院（邮编300222）；2天津市胸科医院心内四科
  • 收稿日期:2020-08-24 修回日期:2020-10-13 出版日期:2021-03-15 发布日期:2021-03-15
  • 通讯作者: 张颖 E-mail:zy89769402@126.com
  • 作者简介:朱慧洁（1995），女，硕士在读，主要从事心血管疾病研究。E-mail：luckyzhu0812@163.com
  • 基金资助:
    天津市卫生行业重点攻关项目（16KG132）

The comparison of the risk stratification and diagnostic strategy of stable chest pain guided by NICE and ESC guidelines by using coronary CT angiography

ZHU Hui-jie1, ZHANG Ying2△, LIU Yu-jie2, ZHOU Jia2   

  1. 1 Thoracic Clinical College, Tianjin Medical University, Tianjin 300222, China; 2 The Forth Department of Cardiology, Tianjin Chest Hospital
  • Received:2020-08-24 Revised:2020-10-13 Published:2021-03-15 Online:2021-03-15

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摘要： 目的　利用冠状动脉CT血管造影（CCTA）验证和比较2016年英国国家卫生与临床优化研究所（NICE）与2019年欧洲心脏病学协会（ESC）指南指导的稳定性胸痛危险分层与诊断策略的优劣。方法　收集2017年1月—2020年1月因稳定性胸痛就诊于天津市胸科医院行CCTA检查的患者1 021例，分别依据NICE、ESC指南的危险分层策略将患者分为低危组与高危组。采用受检者工作特征（ROC）曲线、净重新分类改善（NRI）对指南的危险分层与诊断策略进行验证和比较。结果　共有212例患者经CCTA检查证实为冠心病。ESC与NICE不同危险分层组别中，高危组患者较低危组罹患冠心病的概率更高（NICE：25.62 % vs. 7.69%，χ2=41.866；ESC：45.06% vs. 3.47%，χ2=262.450，均P＜0.01），ESC危险分层策略较NICE有所改善，具有更好的分类能力（NRI=38.54%，P＜0.01）；ESC指南预测冠心病的AUC为0.837（95%CI：0.813~0.860）；依据ESC指南的PTP模型预估患病率总体上低估了观察到的实际患病率（14.63% vs. 20.76%，χ2=13.349，P＜0.01），在男性患者中也存在这种差异（21.25% vs. 32.15%，χ2=13.580，P＜0.01），在女性患者中差异无统计学意义（9.39% vs. 11.75%，χ2=1.561，P＞0.05）。结论　ESC指南对稳定性胸痛的危险分层策略优于NICE，ESC的诊断策略对冠心病具有良好的诊断价值，但总体低估了实际患病率。

关键词: 冠心病, 冠状血管造影术, 计算机体层摄影血管造影术, ROC曲线, 稳定性胸痛, 危险分层, 诊断策略

Abstract: Objective　In view of different risk stratification and diagnostic strategies for patients with stable chest pain, coronary computed tomographic angiography (CCTA) was used to verify and compare the advantages and disadvantages of the risk stratification and diagnostic strategies guided by the 2016 NICE and 2019 ESC guidelines. Methods　A total of 1 021 patients with stable chest pain who underwent CCTA were collected in Tianjin Chest Hospital from January 2017 to January 2020. According to the risk stratification strategy of NICE and ESC guidelines, the patients were divided into low risk group and high risk group. Coronary artery disease (CAD) was defined as stenosis≥50% in diameter at least one segment of the coronary artery by CCTA. The risk stratification and diagnosis strategies of the guidelines were verified and compared by using area under the receiver operating characteristic curve (AUC) and the net reclassification improvement (NRI). Results　Overall, 212 patients were diagnosed as CAD by coronary CCTA examination. Among the different risk stratification groups of ESC and NICE, patients in the high risk group were more likely to develop coronary heart disease than those of the low risk group (NICE: 25.62 % vs. 7.69%, χ2=41.866, P＜0.01; ESC: 45.06% vs. 3.47%, χ2=262.450, P＜0.01). The risk stratification strategy of ESC was improved compared with that of NICE, and which has better classification capabilities (NRI=38.54%, P＜0.01). The ESC guideline predicted that the AUC of coronary heart disease was 0.837 (95%CI: 0.813-0.860). The expected prevalence of coronary heart disease based on the ESC guideline greatly underestimated the observed prevalence (14.63% vs. 20.76%, χ2=13.349, P＜0.01), and this difference also existed in male patients (21.25% vs. 32.15%, χ2=13.580, P＜0.01). There was no significant difference in female patients (9.39% vs. 11.75%，χ2=1.561，P＞0.05). Conclusion　The ESC guideline for stable chest pain is better than that of NICE in the risk strategy of stable chest pain. The diagnostic strategy of ESC guideline has a good diagnostic value for coronary heart disease, but it underestimates the actual prevalence rate.

Key words: coronary disease, coronary angiographycoronary, computed tomography angiography, ROC curve, stable chest pain, risk stratification, diagnostic strategy