陈荣盼 梁国坚 关健威

[摘要]目的 觀察分析64排螺旋CT冠状动脉成像对不典型胸痛冠心病患者的诊断价值。方法 选取2015年10月～2017年10月我院收治的80例不典型胸痛冠心病患者作为研究对象，应用64排螺旋CT行冠状动脉成像进行诊断，并以选择性冠状动脉造影结果为标准，评价该诊断方法结果的准确度、特异度、敏感度。结果 患者采用64排螺旋CT冠状动脉成像检测的准确度、敏感度及特异度分别为87.50%、87.50%、87.50%，64排螺旋CT冠状动脉成像检测与选择性冠状动脉造影的准确度、特异度、敏感度比较，差异均有统计学意义（χ2=10.6667，P=0.0011；χ2=2.1333，P=0.1441；χ2=8.5333，P=0.0035）；采用64排螺旋CT冠状动脉成像检测的轻度狭窄确诊率为75.56%，中度及以上狭窄的确诊率93.98%，两组数据比较，差异有统计学意义（χ2=9.0523，P=0.0026）；64排螺旋CT冠状动脉成像检测右侧冠状动脉、左回旋支、左前降支3个冠脉血管病变分支的敏感度比较，差异有统计学意义（χ2=28.3080，P=0.0001），特异度及准确度比较，差异均无统计学意义（χ2=0.0756，P=0.9629；χ2=2.8489，P=0.2406）。结论 在诊断不典型胸痛冠心病患者时，应用64排螺旋CT冠状动脉成像的效果尚可，但由于其无创性优势，故而可作为基本诊断鉴别手段。

[关键词]不典型胸痛；冠状动脉成像；64排螺旋CT；病变诊断与鉴别

[中图分类号] R741.04 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0127-04

[Abstract] Objective To observe and analyze the diagnostic value of 64-slice spiral computed tomography （CT） coronary angiography in coronary heart disease patients with atypical chest pain. Methods Eighty patients with atypical chest pain who were treated in our hospital from October 2015 to October 2017 were enrolled in this study. Coronary artery imaging with 64-slice spiral CT was used for the diagnosis， and the accuracy， specificity and sensitivity of the diagnosis method were evaluated based on the results of selective coronary angiography. Results The accuracy， sensitivity and specificity of 64-slice spiral CT coronary angiography were 87.50%， 87.50%， and 87.50%， respectively. The comparsion of accuracy， specificity and sensitivity between 64-slice spiral CT coronary angiography and selective coronary angiography showed statistically significant difference （χ2=10.6667， P=0.0011； χ2=2.1333， P=0.1441； χ2=8.5333， P=0.0035）. The diagnosis rates of mild， moderate， and upper stenosis using 64-slice spiral CT coronary angiography were 75.56%， 93.98%， and the difference between the two data was significant （χ2=9.0523， P=0.0026）. The comparsion of sensitivity with 64-slice spiral CT coronary angiography used to detect three coronary vascular lesions in the right coronary artery， left circumflex artery， and left anterior descending coronary artery showed statistically significant difference （χ2=28.3080， P=0.0001）， while there was no statistically significant difference in specificity and accuracy （χ2=0.0756， P=0.9629； χ2=2.8489， P=0.2406）. Conclusion In the diagnosis of atypical chest pain patients with coronary heart disease， the effect of 64-slice spiral CT coronary angiography is acceptable， but because of its non-invasive advantages， it can be used as a basic diagnostic identification method.

[Key words] Atypical chest pain； Coronary angiography； 64-slice spiral computed tomography； Diagnosis and identification of lesions

多層螺旋CT冠状动脉成像在反映患者病变情况时较直观，同时该检查还具备非侵入性、安全性好、性价比高等优点，目前在多种临床疾病的诊断中应用广泛。但该方法亦具有一定的局限性，即诊断轻度狭窄病变的准确度明显低于诊断重度狭窄。……