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目的:通过与传统冠状动脉造影(CAG)对比,探讨双源CT冠状动脉成像(DSCTA)对糖尿病患者合并冠状动脉狭窄的诊断价值。方法:对81例2型糖尿病可疑合并冠心病患者行DSCTA检查,扫描图像经工作站进行多种方法重建,评估管径≥2.0 mm的近端12个节段,筛选出血管狭窄程度≥50%的患者,并采用四格表χ2检验,以CAG为对照分析。结果:81例患者有68例显示血管狭窄程度≥50%,其中42例(61.8%)有多支血管狭窄,68例均行CAG检查。68例共有793支冠状动脉节段显示清晰可评价,可评价率为97.2%。以CAG检查为金标准,DSCTA检测血管狭窄程度≥50%的敏感度、特异度、阳性预测值、阴性预测值分别为95.6%、97.7%、89.7%、99.1%;两种检查方法之间的差异无统计学意义(P>0.05)。DSCTA检测心率<70次/min及≥70次/min的糖尿病患者冠状动脉狭窄的敏感性(97.4%vs 93.2%)、特异性(97.6%vs 97.9%)、阳性预测值(89.4%vs90.2%)、阴性预测值(99.5%vs 98.6%)差异无统计学意义(P>0.05)。结论:DSCTA具有图像清晰、扫描速度快及无创等优点,且不受心率的影响,是有效的冠状动脉检查方法,可作为2型糖尿病患者怀疑合并冠心病的筛查。
Objective: To evaluate the diagnostic value of dual-source CT coronary angiography (DSCTA) in patients with diabetes mellitus complicated with coronary artery stenosis by comparing with traditional coronary angiography (CAG). Methods: Eighty-one patients with suspected type 2 diabetes with coronary heart disease were examined by DSCTA. The images of the patients were reconstructed by workstation. The proximal 12 segments with the diameter ≥2.0 mm were evaluated. The degree of stenosis ≥50% Patients, and using the four grid table χ2 test to CAG as a control. Results: Of the 81 patients, 68 showed stenosis of ≥50%. Forty-two patients (61.8%) had multiple-vessel stenosis and 68 patients underwent CAG. 683 cases of a total of 793 coronary artery segments showed clearly evaluable, evaluable rate was 97.2%. The sensitivity, specificity, positive predictive value and negative predictive value of CTA were 95.6%, 97.7%, 89.7% and 99.1%, respectively. The difference between the two methods was The difference was not statistically significant (P> 0.05). The sensitivity (97.4% vs 93.2%), specificity (97.6% vs 97.9%), and positive predictive value (89.4% vs 90.0%) of coronary artery stenosis in patients with diabetes with heart rate <70 beats / min and ≥70 beats / %), Negative predictive value (99.5% vs 98.6%) was no significant difference (P> 0.05). Conclusion: DSCTA has the advantages of clear image, fast scanning speed and noninvasive advantages, and is not affected by heart rate. It is an effective method of coronary artery examination and can be used as a screening for suspected coronary heart disease in patients with type 2 diabetes mellitus.