电子束CT检测冠状动脉钙化对诊断老年冠心病的价值

目的　探讨电子束CT检测冠状动脉钙化 (CAC)对诊断老年人冠心病的价值。方法　 2 2 9例老年患者行电子束CT检测CAC并计算每例的CAC总积分 ,行选择性冠状动脉造影以确定冠状动脉粥样硬化狭窄的有无及其程度。结果　 (1) 2 2 9例患者中 ,CAC检测阳性 2 2 0例 ,总阳性率 96 .0 7% ;造影显示有 2 13例存在不同程度的冠状动脉狭窄 ,其中 16 8例确诊为冠心病。 (2 )全组CAC诊断老年人冠心病的总体敏感性、特异性、阳性预测值和阴性预测值分别为 99%、13%、76 %和 89% ,诊断老年人冠状动脉粥样硬化的相应指标则分别为 97%、19%、94%和 33%。(3)老年男性组CAC诊断冠心病的敏感性较高特异性较低 ;老年女性则特异性较高而敏感性较低。综合考虑敏感性及特异性 ,对于老年男性 ,以CAC积分为 2 0 0作为诊断冠心病的分值较好 ,而对于老年女性则以 5 0作为诊断分值较佳。结论　电子束CT检测冠状动脉钙化对诊断老年人冠心病具有一定价值 ,但应结合性别和钙化分值进行综合分析。

The diagnostic value of coronary calcification detected by electron beam computed tomography for coronary artery disease in elderly patients

Objective To investigate the diagnostic value of coronary artery calcification (CAC) detected by electron beam computed tomography (EBCT) for coronary artery disease in elderly patients.Methods EBCT was performed for detecting CAC in 229 elderly patients who had undergone selective coronary angiography,and the value of CAC for diagnosing coronary artery disease in elderly patients was evaluated.Results (1)Of the 229 patients,CAC was detected in 220,and the overall positive rate was 96.07%.(2)The overall sensitivity,specificity,positive predictive value and negative predictive value of CAC for diagnosis of coronary artery disease were 99%?13%?76% and 89% respectively,and for detection of any evidence of atherosclerosis,these indexes were 97%?19%?94% and 33% respectively.(3)For diagnosis of coronary artery disease,the sensitivity of CAC was higher and the specificity was lower in elderly men than in elderly women.The cut points of CAC score for diagnosing coronary artery disease in the present study were 200 for elderly men and 50 for elderly women.Conclusion Coronary artery calcification detected by electron beam computed tomography has considerable diagnostic value for coronary artery disease in elderly patients,but the value must be evaluated comprehensively by taking gender and calcification score into consideration.