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【摘要】 目的探讨64层螺旋CT在诊断老年及中青年冠状动脉狭窄的敏感性等指标的差异。方法 对203例经冠状动脉造影证实为冠脉狭窄患者的临床病例资料进行分析。结果 老年患者轻、中、重度冠脉狭窄的敏感性分别为78.3%、79.2%、90.6%;中青年患者之敏感性分别为91.8%、86.7%、91.7%。结论 64层螺旋CT诊断老年冠脉狭窄的敏感性低于中青年,轻、中度狭窄时差异有统计学意义,重度狭窄时敏感性无统计学差异。
【关键词】64层螺旋CT;老年;中青年;冠状动脉狭窄
Contrast Study of 64-slice Spiral CT Detection of Coronary Artery Stenosis in the Elderly and the Young
CHEN Yao-qiang.Futian District,Shenzhen,Guangdong Province People’s Hospital,Department of Radiology,Shenzhen 518033,China
【Abstract】 Objective To discuss the index diference of sensitivity of 64-slice spiral CT in diagnosing coronary artery stenosis in the elderly and the young.Methods An analysis was made to the clinical data of 203 cases with coronary artery stenosis conformed by coronaryangiography.Results The sensitivities of the elderly with mild,moderate and severe coronary artery stenosis were 78.3%,79.2% and 90.6% respectively while those of the young were 91.8%,86.7% and 91.7% respectively.Conclusion The sensitivity of 64-slice spiral CT in diagnosing coronary artery stenosis of the elderly is lower than that of the young,the diference is of statistical sign ificance in diagnosing the mild and moderate stenosis but of no statistical significance in diagnosing the severe stenosis.
【Key words】64-slice spiral CT the elderly; The young coronary artery stenosis
了解64层螺旋CT检测老年(≥60岁)与中青年(65bpm的患者在CT检查前1~2 h服用倍他乐克25~50 mg,使心率控制在 特异性(%)96.199.4.**97.099.4.**98.299.6.#
阳性预测值(%)79.290.7.#82.092.9.#84.188.0.#
阴性预测值(%)96.499.0.*97.499.0.#99.099.7.#
注:老年组与中青年组比较,.*P0.05
3 讨论
SCA是诊断冠状脉狭窄的金标准,是目前时间和空间分辨力最好的检查手段[3],但其费用高、有创,偶有严重并发症是其重要缺点,而多层螺旋CT(MultiSlices computed tomography,MSCT)诊断冠脉狭窄以其敏感性高、特异性好,且无创、简便、安全、经济、快捷而受到普遍重视。MSCT是目前为止唯一能诊断软斑块的无创检查[4],现已被广泛应用于冠脉狭窄的临床诊断[5,6]。
本组资料中64层螺旋CT检测老年与中青年冠脉管腔可评价率分别为93.0%、98.0%(P10次/min、位于冠状动脉远端分支等原因而无法对管腔进行评价。
64层螺旋CT诊断老年轻、中、重度冠脉狭窄的敏感性、特异性、阳性预测值、阴性预测值均略低于中青年。二者均有随冠脉狭窄程度的增加而逐渐上升的趋势。冠脉轻度狭窄时,冠脉CT诊断老年与中青年冠脉狭窄的敏感性、特异性、阳性预测值、阴性预测值均较低,但二者均有统计学差异,老年低于中青年。冠脉重度狭窄时,冠脉CT诊断老年与中青年冠脉狭窄的敏感性、特异性、阳性预测值、阴性预测值均较高,但除特异性外二者差异无统计学意义,与近年国内外报道的敏感83%~87%,特异性95%~97%,阳性预测值71%~82%,阴性预测值95%~98%[8]接近,表明64层CT诊断冠脉狭窄与SCA比较,准确性已达到相当高的程度,值得临床广泛推广应用,尤其在冠脉介入治疗和冠脉“搭桥”手术前应作为SCA前的基础筛查。
64层螺旋CT诊断老年与中青年轻、中、重度冠脉狭窄的特异性均高于敏感性,阴性预测值均高于阳性预测值,说明64层螺旋CT诊断冠脉狭窄的否定性指标要优于肯定性指标,排除性指标要优于诊断性指标,即64层螺旋CT排除有该程度冠脉狭窄者而实际罹患该程度冠脉狭窄的比例和可能性非常小,这部分患者甚至可以不必再作SCA检查,以减少患者的痛苦和经济负担。
MSCT诊断冠脉狭窄虽有不少优点,但与SCA金标准相比,仍存在少数误诊和漏诊。运动伪影和心率偏快是导致MSCT漏诊,出现假阴性的主要原因;血管壁大面积的钙化斑块可能导致MSCT高估血管壁狭窄程度,是出现误诊和假阳性的主要原因[9]。随着MSCT技术的迅速发展,可以预期,这些影响因素将会被逐渐克服,MSCT诊断冠脉狭窄的技术将会更进一步完善。
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