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目的探讨中老年非典型胸痛患者无创性检查对冠心病的诊断价值。方法113例中老年胸痛患者分为急性冠状动脉综合征55例(A组),非典型胸痛58例(B组),均接受冠状动脉造影(CAG)检查,分析冠状动脉病变阳性率和食管心房调搏负荷试验(TEAPT)阳性并伴有冠心病危险因素的关系。结果B组(17.2%)有冠心病明显低于A组(92.3%),P<0.01。B组中血脂水平、血糖水平、高血压发病率均低于A组,P<0.05。TEAPT阳性伴有冠心病危险因素对中老年非典型胸痛(B组)诊断冠心病的敏感性54.5%,特异性97.9%,准确性89.7%。B组以单支血管病变为主,显著高于A组(90.0%,38.2%,P<0.05)。A、B两组累及血管顺序均为左降支(LAD)、右冠状动脉(RCA)、左回旋支(LCX)(38.2%、28.1%、33.7%及36.4%、27.3%、36.4%,P>0.05)。病变分型均以A型多见(66.2%及63.6%,P>0.05),其次为B型(25.9%及27.3%,P>0.05),C型少见。结论ECG可反映当时动脉粥样斑块破裂伴血栓形成、血流阻断血管的对应病变;中老年非典型胸痛或非典型胸痛伴冠心病危险因素诊断冠心病要慎重;TEAPT阳性伴有冠心病危险因素,可提高冠心病诊断的正确率,为筛选阳性病例行CAG检查、明确诊断、尽早行药物或介入治疗提供客观依据。
Objective To investigate the diagnostic value of noninvasive examination of coronary heart disease in middle-aged and elderly patients with atypical chest pain. Methods A total of 113 middle-aged and elderly patients with chest pain were divided into 55 cases of acute coronary syndrome (group A) and 58 cases of atypical chest pain (group B), all underwent coronary angiography (CAG). The positive rates of coronary artery disease and esophageal atrium Pacemaker stress test (TEAPT) positive and associated with coronary heart disease risk factors. Results In group B (17.2%), coronary heart disease was significantly lower than that in group A (92.3%), P <0.01. In group B, the level of blood fat, blood glucose and the incidence of hypertension were lower than those in group A (P <0.05). The sensitivity and specificity of TEAPT-positive CHD risk factors for diagnosis of CHD in middle-aged and elderly patients (group B) were 54.5%, 97.9% and 89.7% respectively. Group B was predominantly single vessel disease, which was significantly higher than that of group A (90.0%, 38.2%, P <0.05). The vascular sequences involved in both A and B groups were left anterior descending artery (LAD), right coronary artery (RCA), left circumflex artery (LCX) (38.2%, 28.1%, 33.7% and 36.4%, 27.3%, 36.4%, P > 0.05). The types of lesions were more common in type A (66.2% and 63.6%, P> 0.05), followed by type B (25.9% and 27.3%, P> 0.05). Conclusion ECG can reflect atherosclerotic plaque rupture associated with thrombosis, blood flow blocking the corresponding pathological changes; atypical atypical chest pain or atypical chest pain with coronary heart disease risk factors in the diagnosis of coronary heart disease should be careful; TEAPT positive with coronary heart disease Risk factors can improve the accuracy of diagnosis of coronary heart disease, CAG screening for screening positive cases, a clear diagnosis, as early as possible drug or intervention provide an objective basis.