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目的分析冠心病患者合并肾动脉狭窄时的心绞痛临床特点,并判断其对冠心病的诊断价值。方法对象为1998年1月至2005年5月同时进行肾动脉和冠状动脉造影的住院患者2820例。心绞痛3组症状包括时间性质部位符合心绞痛、劳力情绪诱发和休息硝酸甘油缓解。任何一支肾动脉和冠状动脉血管直径狭窄超过50%可以分别诊断为肾动脉狭窄和冠心病。结果合并肾动脉狭窄组243例(85.6%),无肾动脉狭窄组2577例。以胸痛休息硝酸甘油缓解、劳力情绪诱发、时间性质部位符合心绞痛等一组症状,诊断合并肾动脉狭窄的冠心病患者,敏感性分别为94.2%、69.7%和75.5%,特异性14.3%、40.0%和25.7%,阳性预测值86.7%、87.3%和85.8%,阴性预测值29.4%、18.2%和15.0%。以胸痛休息硝酸甘油缓解和劳力情绪诱发、时间性质部位符合心绞痛和劳力情绪诱发、时间性质部位符合心绞痛和休息硝酸甘油缓解等2组症状,诊断合并肾动脉狭窄患者的冠心病,敏感性分别为68.8%、56.7%和72.6%,特异性40.0%、62.9%和45.7%,阳性预测值87.2%、90.1%和88.8%,阴性预测值17.7%、19.6%和21.9%。心绞痛3组症状对于合并肾动脉狭窄患者的冠心病的诊断,敏感性为56.4%、特异性62.9%、阳性预测值90.0%和阴性预测值19.5%。结论心绞痛1组、2组或3组症状,对于冠心病诊断的敏感性和漏诊率以及多数特异性和误诊率,在是否合并肾动脉狭窄的患者中无显著差异,在肾动脉狭窄的患者中,阳性预测值偏大、阴性预测值偏小。
Objective To analyze the clinical features of angina pectoris in patients with coronary heart disease complicated with renal artery stenosis and to determine its diagnostic value in coronary heart disease. Methods: The data of 2820 hospitalized patients with simultaneous renal artery and coronary angiography from January 1998 to May 2005 were analyzed. Symptoms of angina pectoris 3 include time-nature sites consistent with angina pectoris, labor-induced mood and resting nitroglycerin remission. Any renal artery and coronary artery stenosis of more than 50% can be diagnosed as renal artery stenosis and coronary heart disease. Results There were 243 cases (85.6%) with renal artery stenosis and 2577 cases without renal artery stenosis. The patients with coronary heart disease complicated with renal artery stenosis were 94.2%, 69.7% and 75.5% respectively, specificity 14.3% and 40.0 % And 25.7%, positive predictive value 86.7%, 87.3% and 85.8%, negative predictive value 29.4%, 18.2% and 15.0%, respectively. Resting nitroglycerin with chest pain relief and labor-induced emotion, time and place consistent with angina and labor-induced emotional part of the time consistent with angina and rest nitroglycerin, and other two groups of symptoms, diagnosis of coronary artery disease in patients with renal artery stenosis, the sensitivity was 68.8%, 56.7% and 72.6%, specificity 40.0%, 62.9% and 45.7%, positive predictive value 87.2%, 90.1% and 88.8%, negative predictive values 17.7%, 19.6% and 21.9% respectively. The three groups of angina symptoms showed a sensitivity of 56.4%, a specificity of 62.9%, a positive predictive value of 90.0% and a negative predictive value of 19.5% for the diagnosis of coronary heart disease in patients with renal artery stenosis. Conclusions The sensitivity, misdiagnosis rates, and the majority of specific and misdiagnostic rates of angina pectoris group 1, 2, or 3 were not significantly different between patients with and without renal artery stenosis , Positive predictive value is too large, negative predictive value is small.