心肌灌注显像与双源CT冠状动脉成像对糖尿病并发冠心病患者冠状动脉狭窄诊断价值的比较

摘要

目的:评估并比较心肌灌注显像(MPI)与双源 CT冠状动脉成像(DS-CTCA)检查对糖尿病并发冠心病(CHD)患者冠状动脉狭窄的诊断价值,阐明2种检查方法联合对糖尿病并发 CHD患者的临床应用价值.方法:选取52例诊断为糖尿病并发CHD患者,分别接受 MPI与 DS-CTCA检查,比较2种检查方法诊断左主干(LM)、左前降支(LAD)、左回旋支(LCX)和右冠状动脉(RCA)等冠状动脉主干分支狭窄程度的差异.以冠状动脉血管造影(CAG)为金标准,比较2种检查方法单独诊断的灵敏度、敏感度和准确度的差异,比较2种检查方法联合平行诊断与系列诊断的灵敏度、敏感度和准确度的差异.结果:MPI检查与DS-CTCA检查对 LM和 LAD的狭窄程度诊断差异无统计学意义(P>0.05),对 LCX和 RCA的狭窄程度诊断差异有统计学意义(P0.05),but the stenosis degrees of LCX and RCA were different between two imaging examination methods(P<0.05).Compared with MPI examination, the sensitivity of DS-CTCA examination in the diabetic patients with CHD was decreased(71.0%vs 90.1%),and the difference was significant(P=0.035);the specificity of DS-CTCA examination in the diabetic patients with CHD was increased(85.7%vs 58.4%),and the difference was significant(P=0.027);but the accuracies of two examinations in the diabetic patients with CHD were no different(76.4%vs 78.4%)(P=0.062).Compared with parallel diagnosis,the specificity and accuracy of serial diagnosis were increased(93.5% vs 33.8%,P=0.001;94.7%vs 71.2%,P = 0.030);but the sensitivities had no difference(95.4% vs 93.1%,P = 0.074). Conclusion:The diagnostic accuracy of evaluating the degree of coronary artery stenosis in the diabetic patients with CHD is not different between DS-CTCA examination and MPI examination. And the serial diagnosis of two examination methods can improve the diagnostic accuracy.