陈惠颜 陈浩刚 代少华 陈艺英 梁翠娟

【摘要】 目的：探索运动平板试验诱发室性心律失常在冠心病诊断中的应用价值。方法：选取2015年6月-2019年4月在笔者所在医院行平板运动试验诱发室性心律失常患者68例。所有患者在平板运动试验后再进行冠状动脉造影。观察平板运动结果对冠心病诊断的敏感性与特异性;对比分析平板运动试验诱发室性心律失常在冠状动脉造影阳性患者与阴性中的表现。结果：平板运动试验对诊断冠心病的敏感性、特异性、假阳性率和假阴性率分别为87.8%、85.2%、14.8%和12.2%。冠状动脉造影阳性患者中频发、多源、成对室早发生率及短阵室速发生率显著高于阴性患者，且差异有统计学意义（P<0.05）。结论：运动平板试验可诱发室性心律失常，发现隐性的心肌缺血情况，其诱发的频发、多源、成对室早及短阵室速等可以作为冠心病诊断的参考依据。

【关键词】 运动平板试验 冠状动脉造影 冠心病 心律失常

[Abstract] Objective： To explore the value of ventricular arrhythmia which induced by treadmill exercise test in the diagnosis of coronary heart disease. Method： A total of 68 patients with ventricular arrhythmia induced by treadmill exercise test in our hospital from June 2015 to April 2019 were selected. All patients were underwent coronary angiography after treadmill exercise test. The sensitivity and specificity of treadmill exercise test in the diagnosis of coronary heart disease were observed and the manifestations of ventricular arrhythmia induced by treadmill exercise test in patients with positive and negative coronary angiography were analyzed. Result： The sensitivity， specificity， false positive rate and false negative rate of treadmill exercise test in the diagnosis of coronary heart disease were 87.8%， 85.2%， 14.8% and 12.2% respectively. The incidence of frequent， multi-source， paired premature ventricular tachycardia and paroxysmal ventricular tachycardia in patients with positive coronary angiography were significantly higher than those in patients with negative coronary angiography （P<0.05）. Conclusion： Exercise treadmill test can induce ventricular arrhythmia and detect occult myocardial ischemia. Frequent， multi-source， paired ventricular premature and short paroxysmal ventricular tachycardia induced by treadmill exercise test can be used as a reference for the diagnosis of coronary heart disease.

冠心病（coronary heart disease，CHD）在心血管系統疾病中是最为常见的类型，在中老年人群中发病率较高。有研究表明，全世界每年总死亡人数中有1/5是由于心血管系统疾病原因死亡，严重威胁人类的身心健康与生命安全[1]。如此高的占比也越来越引起全球医学界对其的关注度。目前来说，对于冠心病的防治，普遍认为早期诊断意义更大。但是冠心病在其病理发生发展过程中比较缓慢，尤其在发病早期，临床诊断上难以发现[2-3]。在冠心病诊断中，以冠状动脉造影为其诊断“金标准”，但其弊端在于技术要求难度大、价格高、禁忌证多等[4];而平板运动试验（treadmill exercise test，TET）近年来以其操作简单、价格优廉、可重复性及无创性等优点被越来越广泛应用于临床诊断[4-5]。……