目的：探讨平板运动试验（TET）与冠状动脉CT血管成像（CTA）在冠心病诊断中的应用价值。方法选择2012年6月—2014年10月在上海交通大学医学院附属第三人民医院就诊的疑似冠心病患者619例，经冠状动脉造影（ CAG）确诊为冠心病330例，非冠心病289例；其中448例患者行TET，171例患者行冠状动脉CTA。以CAG作为金标准，观察TET与CTA对冠心病的诊断效能，并分析冠心病患者冠状动脉病变支数、狭窄程度及病变位置对两者诊断结果的影响。结果 TET诊断冠心病的灵敏度为76.9%，特异度为42.7%，准确率为59.2%；CTA诊断冠心病的灵敏度为94.7%，特异度为66.7%，准确率为85.4%。TET对冠心病患者冠状动脉不同病变支数及病变位置（狭窄率>50%）的检出率比较，差异无统计学意义（χ2值分别为1.039、3.452，P>0.05）；TET对冠心病患者冠状动脉狭窄程度及病变位置（狭窄率>70%）的检出率比较，差异有统计学意义（χ2值分别为9.776、6.599，P <0.05）。冠状动脉CTA对冠状动脉不同病变支数、狭窄程度、病变位置（狭窄率>50%）的检出率比较，差异无统计学意义（χ2值分别为0.121、0.508、0.887，P>0.05）。结论 TET及冠状动脉CTA对冠心病均具有一定的诊断价值，但TET更安全、无创，冠状动脉CTA的诊断效能更高，临床上应根据患者情况进行选择。%Objective To explore the application value of treadmill exercise test( TET) and coronary CTA in the diagnosis of coronary heart disease. Methods From Jane 2012 to October 2014,a total of 619 patients with suspected coronary heart disease were selected in the Third People′s Hospital Affiliated to Medicine School,Shanghai Jiaotong University,all of them received CAG examination,and eventually 330 cases confirmed as coronary heart disease,289 confirmed as non coronary heart disease. Of the 619 cases,448 cases received TET,171 cases received coronary CTA. Take CAG as gold standard,the diagnostic efficiency of TET and coronary CTA was respectively observed,and influences of stenosed coronary artery number, coronary artery stenosis severity and coronary artery lesion location of patients with coronary heart disease on the diagnostic efficiency of TET and coronary CTA were analyzed. Results The sensitivity of TET in diagnosing coronary heart disease was 76. 9%,the specificity was 42. 7%,the accuracy rate was 59. 2%;the sensitivity of coronary CTA in diagnosing coronary heart disease was 94. 7%,the specificity was 66. 7%,the accuracy rate was 85. 4%. In coronary heart disease patients with different stenosed coronary artery numbers and different coronary artery lesion locations( with stenosis rate over 50%),the detectable rate of TET showed no statistically significant differences(χ2 =1. 039,3. 452,P>0. 05);while in coronary heart disease patients with different coronary artery stenosis severities and different coronary artery lesion locations( with stenosis rate over 70%),the detectable rate of TET showed statistically significant differences(χ2 =9. 776,6. 599,P<0. 05). In coronary heart disease patients with different stenosed coronary artery numbers,different coronary artery stenosis severities and different coronary artery lesion locations( with stenosis rate over 50%),the detectable rate of coronary CTA showed no statistically significant differences (χ2 =0. 121,0. 508,0. 887,P>0. 05). Conclusion Both of TET and coronary CTA have certain diagnostic value in the diagnosis of coronary heart disease,TET is safe and noninvasive,but the diagnostic efficiency of coronary CTA is relatively higher,choice of examination method should be made based on the patients′s conditions.
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