【作者】 刘琦； 郎勇； 王波； 陈晓琴； 张永宏； 王岚； 周力；

【Author】 Liu Qi~1,Lang Yong~2,Wang Bo~3,Chen Xiao-qin~1,Zhang Yong-hong~1,Wang Lan~1,Zhou Li~1.(1 Department of Digestive Medicine,2 Department of Cardiology,3 Radiology Department,The First Affiliated Hospital,Guiyang Medical College,Guiyang 550004 )

【机构】 贵阳医学院附属医院；

【摘要】 目的探讨利用心脏320排冠脉CT(CTA)和常规心电图(ECG)无创筛查老年消化道出血患者是否合并潜在冠心病的临床应用价值。方法选择71例既往无冠心病病史的老年消化道出血患者,其中上消化道出血56例,下消化道出血10例,消化道大出血5例,所有患者入院后2周内依次完成常规12导联心电图,心脏320排动态容积CT冠状动脉成像检查,其中26例患者6周内接受了冠状动脉造影(CAG)检查,采用McNemar检验来比较每两种检测方法筛查消化道出血患者是否合并冠心病的临床价值。结果71例患者中,29例CTA冠心病诊断阳性,而ECG测定19例为阳性,结果提示两种检测方法存在统计学差异(P=0.041),以CTA检测的阳性率较高,卡方优势性检验提示CTA法优于ECG法。而在26例冠状动脉造影的患者中,16例CTA阳性,10例阴性,15例CAG阳性,11例阴性。CTA法诊断老年消化道出血患者合并冠心病的灵敏度为100.00%,特异度90.91%%,阳性预测值93.75%,阴性预测值100.00%。结论心脏320排CT冠脉成像可以作为一项无创筛查老年消化道出血患者是否合并冠心病的临床首选检测方法,而常规心电图的这一应用价值较低。更多还原

【Abstract】 Objective The purpose of the study was to assess the non-invasive diagnostic value of 320-row coronary angiography with CT(CTA) as compared with conventional electrocardiogram (ECG) in gastrointestinal hemorrhage patients with potential coronary artery disease.Methods A total of 71 gastrointestinal bleeding patients without coronary heart disease(CHD) history which including 56 upper gastrointestinal hemorrhage patients,10 lower gastrointestinal hemorrhage patients and 5 severe gastrointestinal hemorrhage patients were studied by using 320-row CTA as compared with conventional 12-director ECG.Among those patients,26 accepted the x-ray coronary angiography(CAG) examination.The McNemar’s test was used to determine statistical differences for diagnosing gastrointestinal hemorrhage patients with potential CHD from ECG, CTA and CAG,CTA examine results.Results In all 71 patients,29 who positive coronary heart disease test results were obtained using 320-row CTA and only 19 were gotten using ECG.There were statistical significance between the two methods(P=0.041).The positive test results from 320-row CTA were significantly higher than from ECG.There were not statistical significance for diagnosing CHD patients between CTA and CAG.According to CAG is the"Golden Criteria"for diagnosing CHD,CTA gained an accuracy of 96.15%(sensitivity 100.00%and specificity 90.91 %).Conclusions Coronary 320-row multidetector CT angiography can be used as a simple replacement for depicting or ruling out coronary artery disease in patients with gastrointestinal hemorrhage and ECG has the lower diagnostic value for this.更多还原