活动平板试验在男性冠心病中的诊断价值

陈桂坚 黄华 彭志坚

[关键词] 活动平板试验;男性;冠心病;冠状动脉造影

[中图分类号] R541.4          [文獻标识码] B          [文章编号] 1673-9701（2021）29-0053-03

Value of treadmill exercise test in diagnosis of male coronary heart disease

CHEN Guijian   HUANG Hua   PENG Zhijian

Department of Cardiology，the Second People's Hospital of Shantou City in Guangdong Province，Shantou   515011，China

[Abstract] Objective To evaluate the diagnostic value of electrocardiogram treadmill exercise test （TET）of male coronary heart disease. Methods A total 120 male patients with suspected coronary heart disease admitted to our hospital from January 2018 to January 2020 were randomly selected. They were given electrocardiogram treadmill exercise test followed by coronary angiography（CAG）. The patients were stratified according to age （<50 years old， 50-60 years old， >60 years old）. The sensitivity and specificity of treadmill exercise test were evaluated. Analysis was conducted to investigate whether the △ST/△HR index method can improve the sensitivity and specificity of treadmill exercise test. Results In men with coronary heart disease， the sensitivity of treadmill exercise test was 76.67% and the specificity was 53.33%. In different age subgroups， the true positive rate was 96.15% （<50 years old subgroup）， 86.67% （50-60 years old subgroup） and 66.67% （>60 years old subgroup），with statistically significant differences （P<0.05）. The △ST/△HR index could improve the sensitivity and specificity of treadmill exercise test. Conclusion Treadmill exercise test has certain value in the diagnosis of male coronary heart disease. As the age increases，the specificity of treadmill exercise test decreases. The degree of ST-segment depression and the degree of increased heart rate（i.e.， △ST/△HR） can improve the sensitivity and specificity of treadmill exercise test， which is of great significance in the diagnosis of male coronary heart disease.

[Key words] Treadmill exercise test;Men;Coronary heart disease;Coronary arteriography

随着医疗技术的不断进步，目前检查冠心病的方法非常多，如心电图、动态心电图、活动平板试验、冠状动脉CTA及冠状动脉造影（Coronary arteriography，CAG）等，而活动平板试验（Treadmill exercise test，TET）是心电图负荷试验，其通过对比分析静止状态下及活动下心电图的变化，从而了解心肌是否存在缺血（是否有心绞痛），且因其无创、简便易行及费用低等优势，目前仍是临床上筛选冠心病的一种常用检查手段[1]，但因多种因素的影响，且常规活动平板试验是单纯以ST段改变程度评估，从而导致活动平板试验有一定的假阳性及假阴性，而CAG是诊断冠心病的“金标准”[2-3]。本研究通过TET与CAG结果比较，探讨TET诊断男性冠心病的敏感度、特异度及其诊断价值，并探讨各年龄组真阳性率是否有差异及如何更好地提高TET诊断男性冠心病的准确性，现报道如下。

1 资料与方法

1.1 一般资料

随机选取2018年1月至2020年1月收住我院心血管內科的120例可疑冠心病的男性患者先后行活动平板试验和冠状动脉造影检查，年龄37～75岁，平均（56.00±6.20）岁，有劳力性胸闷、胸痛者63例，不典型胸痛、胸闷者29例，心悸、气短者13例，余15例存在ST-T改变，合并高血压28例，合并糖尿病24例，合并轻度肺气肿12例。所有患者均排除心肌梗死、心肌病、严重心脏瓣膜病、严重肺气肿、严重心律失常、心包炎、心力衰竭及曾行冠状动脉搭桥术等病史。

1.2 方法

所有患者先后行TET及CAG检查，且检查前均停用硝酸酯类、非二氢吡啶类钙阻滞药及β受体阻滞剂等改善心肌缺血药物，停用洋地黄类药物及抗心律失常类药物。……