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目的评价运动负荷心电图试验(EET)、运动负荷心肌灌注核素显像(SPECT)对冠状动脉病变的诊断价值。方法以冠状动脉造影(CAG)检查为标准,对127例疑似冠心病的受检对象,同步进行EET、SPECT、CAG检查,并对比分析。结果EET、SPECT、EET加SPECT检查诊断冠心病的敏感性分别为94.9%、89.5%;特异性分别为14.8%、24.4%;准确性分别为38.6%、41.7%,阳性预测值分别为34.9%和36.6%。对诊断冠脉病变的敏感性分别为88.8%和81.5%;特异性分别为25.5%和41.3%,准确性分别为65.4%和60.6%,阳性预测值分别为67.0%和71.0%;P值均>0.05。EET加SPECT诊断冠心病的敏感性和特异性分别为100%和13.7%,诊断冠脉病变敏感性和特异性分别为100%和25.9%。结论EET和运动负荷SPECT两种无创性检查在筛选诊断冠心病和冠脉病变的临床价值相近,两者合用未明显提高对冠心病的诊断价值。EET加SPECT仅有助于提高诊断冠心病的敏感性。EET以其经济花费少和无辐射损伤的优点更适合应用于基层医院。
Objective To evaluate the diagnostic value of exercise-stress electrocardiogram (EET) and exercise-loaded myocardial perfusion nuclide imaging (SPECT) in the diagnosis of coronary artery disease. Methods According to coronary angiography (CAG) as the standard, 127 subjects with suspected coronary heart disease were examined simultaneously by EET, SPECT and CAG, and compared. Results The sensitivities of EET, SPECT, EET and SPECT in diagnosing CHD were 94.9% and 89.5% respectively, the specificity were 14.8% and 24.4% respectively, the accuracy was 38.6% and 41.7% respectively, and the positive predictive value were 34.9% And 36.6%. The sensitivity for diagnosing coronary artery disease was 88.8% and 81.5% respectively; the specificity was 25.5% and 41.3% respectively, the accuracy was 65.4% and 60.6% respectively, and the positive predictive value was 67.0% and 71.0% > 0.05. The sensitivity and specificity of EET plus SPECT in diagnosing CHD were 100% and 13.7%, respectively. The sensitivity and specificity of diagnosing coronary lesions were 100% and 25.9% respectively. Conclusion Both EET and SPECT noninvasive examination have similar clinical value in the screening of coronary heart disease and coronary artery disease. The combination of EET and exercise SPECT did not improve the diagnostic value of coronary heart disease. EET plus SPECT can only help improve the diagnosis of coronary heart disease. EET is more suitable for primary care hospitals because of its low cost and no radiation damage.