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目的探讨利用心电图运动试验(S-ECG)和核素灌注心肌显像负荷试验(S-MPS)在非典型胸痛患者临床诊断中的价值。方法对非典型胸痛为主诉、临床诊断明确且 S-ECG、S-MPS、冠状动脉(冠脉)造影和冠脉痉挛激发试验资料完整的患者为研究对象,回顾性分析两种负荷试验结果并与最后诊断进行对照分析。结果资料完整的186例非典型性胸痛患者,最后诊断冠心病患者占20%,冠脉痉挛占27%,冠脉肌桥占14%,X 综合征5%,非冠脉疾病占34%。在除外冠脉痉挛后,S-ECG 诊断冠脉缺血性病变的敏感性和特异性分别为92%和65%;S-MPS 的敏感性和特异性分别为62%和79%。非典型胸痛患者中 S-ECG 阴性,但 S-MPS 呈反向再分布诊断冠脉痉挛的敏感性和特异性分别为94%和96%。结论非典型胸痛患者中多数具有缺血意义的冠脉病变基础,联合负荷试验对鉴别诊断具有重要临床价值。
Objective To explore the value of S-ECG and S-MPS in the clinical diagnosis of atypical chest pain. Methods Atypical chest pain was the chief complaint. Patients with definite clinical diagnosis and complete test data of S-ECG, S-MPS, coronary (coronary) angiography and coronary artery spasm were included in this study. The results of two load tests were retrospectively analyzed Control analysis with final diagnosis. Results 186 cases of atypical chest pain were completed. The final diagnosis of coronary heart disease accounted for 20%, coronary artery spasm 27%, coronary artery bridge 14%, syndrome X 5%, non-coronary disease 34%. Sensitivity and specificity of S-ECG in the diagnosis of coronary ischemic lesions were 92% and 65%, respectively, except for coronary artery spasm; the sensitivity and specificity of S-MPS were 62% and 79%, respectively. S-ECG was negative in patients with atypical chest pain, but the sensitivity and specificity of S-MPS in reverse redistribution to diagnose coronary artery spasm were 94% and 96%, respectively. Conclusions Most patients with atypical chest pain have the basis of ischemic coronary artery disease. Combined load test has important clinical value in differential diagnosis.