冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠状动脉硬化性心脏病的价值研究

摘要 目的：探讨冠状动脉CTA结合动态心电图夜间ST段趋势图对冠状动脉硬化性心脏病（冠心病）的诊断价值。方法：回顾性分析2022年1月-2023年2月在我院疑似冠心病的患者104例，所有患者均行冠状动脉造影、冠状动脉CTA、动态心电图及临床相关实验室检查。以冠状动脉造影结果作为诊断冠心病的金标准，分析比较冠状动脉CTA、动态心电图夜间ST段趋势图及两者联合诊断冠心病的诊断效能和一致性。结果：104例疑似冠心病的患者确诊93例（89.42%）。冠状动脉CTA诊断冠心病的敏感性为90.32%，特异性为72.73%，阳性预测值为96.55%，阴性预测值为47.06%，准确率为88.46%，与冠状动脉造影的Kappa值为0.813，一致性好。动态心电图夜间ST段趋势图诊断冠心病的敏感性为84.95%，特异性为63.64%，阳性预测值为95.18%，阴性预测值为33.33%，准确率为82.69%，与冠状动脉造影的Kappa值为0.724，一致性较好。有夜间ST段动态改变的冠心病检出率（84.95%，79/93）明显高于无夜间ST段动态改变的冠心病检出率（15.05%，14/93），差异有统计学意义（P＜0.001）。冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠心病的敏感性为96.77%，特异性为90.91%，阳性预测值为98.90%，阴性预测值为76.92%，准确率为96.15%，与冠状动脉造影的Kappa值为0.923，一致性好。结论：冠状动脉CTA结合动态心电图夜间ST段趋势图诊断冠心病的临床价值优于冠状动脉CTA或动态心电图夜间ST段趋势图单独检查。

Study on the Value of Coronary Artery CTA Combined with ST Segment Trend Chart of Dynamic Electrocardiogram at Night in the Diagnosis of Coronary Atherosclerotic Heart Disease

ABSTRACT Objective: To investigate the diagnostic value of coronary artery CTA combined with ST segment trend chart of dynamic electrocardiogram at night in coronary atherosclerotic heart disease (coronary heart disease). Methods: A retrospective analysis of 104 patients with suspected coronary heart disease in our hospital from January 2022 to February 2023 was performed. All patients underwent coronary angiography, coronary CTA, dynamic electrocardiogram and clinical related laboratory tests. The results of coronary angiography were used as the gold standard for the diagnosis of coronary heart disease. The diagnostic efficacy and consistency of coronary CTA, ST segment trend chart of dynamic electrocardiogram at night and the combination of the two in the diagnosis of coronary heart disease were analyzed and compared. Results: 93 (89.42%) of 104 suspected coronary heart disease cases were confirmed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of coronary artery CTA in the diagnosis of coronary heart disease were 90.32%, 72.73%, 96.55%, 47.06%, and 88.46%, which were in good agreement with the Kappa value 0.813 of coronary artery angiography. The sensitivity,specificity, positive predictive value and negative predictive value were 84.95%, 63.64%, 95.18%, 33.33% and 82.69% in the diagnosis of coronary artery disease by ST segment trend chart of dynamic electrocardiogram at night, which was in good agreement with the Kappa value 0.724 of coronary artery angiography. The detection rate of coronary heart disease with dynamic changes of ST segment at night(84.95%,79/93) was significantly higher than that no dynamic changes of ST segment at night(15.05%,14/93), and the difference was statistically significant(P<0.001). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of coronary CTA combined with ST segment trend chart of dynamic electrocardiogram at night in the diagnosis of coronary heart disease were 96.77%, 90.91%, 98.90%, 76.92% and 96.15%. The Kappa value of coronary angiography was 0.923, and the consistency was good. Conclusion: The clinical value of coronary CTA combined with ST segment trend chart of dynamic electrocardiogram at night in the diagnosis of coronary heart disease is better than that of coronary CTA or ST segment trend chart of dynamic electrocardiogram at night alone.