冠脉CTA在冠心病诊断中的应用研究

目的评价与分析冠脉CTA在冠心病诊断中的价值。方法回顾性选取2011年1月至2013年10月来煤炭总医院检查拟诊断为冠心病的患者168例为研究对象，先进行冠脉CTA检查，然后再进行冠脉造影检查，以冠状动脉造影为“金标准”，对冠脉CTA检查结果进行分析，得出冠脉CTA在诊断冠心病中的敏感度、特异度、阳（阴）性预测值等，分析其在冠心病诊断中的价值。结果①按照病例数：168例患者经过CAG检查123例确诊为冠心病，冠脉CTA检出125例，两种检查同时诊断冠心病患者120例。②按照病变血管：左主干病变CAG检出24例，冠脉CTA检出30例，二者共同检出23例；前降支病变CAG检出98例，冠脉CTA检出103例，误诊7例，漏诊2例；回旋支病变CAG检出69例，冠脉CTA检出74例，误诊8例，漏诊3例；右冠病变CAG检出71例，冠脉CTA检出68例，误诊5例，漏诊8例（5例均为右冠远端病变）。结论冠脉CTA对冠心病患者冠脉自身病变有着较高的灵敏度和特异度，可作为冠心病筛查和诊断首选的无创性检查。

The application of coronary CTA in the assessment of coronary artery disease

Objective To evaluate the value and insufficient of coronary CTA in the diagnosis of coronary heart disease. Methods 168 patients suspected CHD who underwent coronary CTA and coronary arteriography from January 2011 to October 2013 in our hospital were analyzed. The sensitivity, specifity, the positive and nega- tive predictive values were evaluated. Results （1）There were 123 patients and 125 patients were diagnosed with coronary heart disease by the CAG and coronary CTA respectively, in which 120 cases were diagnosed by the two methods. （2）According to lesion vessel： the left main lesion were detected by CAG were 24 cases, by coronary CTA were 30 cases, among them 23 eases were detected by two methods. For LAD, 98 cases and 103 cases were detected by CAG and CTA respectively. In CTA group, there were 7 eases of misdiagnosis, 2 cases missed diag- nosis. For LCX lesions, there were 69 cases and 74 cases were diagnosed by CAG and CTA respectively. In CTA group, there were 8 cases of misdiagnosis, 3 eases of missed diagnosis. For RCA lesion, there were 71 eases and 68 eases detected by CAG and CTA respectively. In CTA group, there were 5 eases of misdiagnosis, 8 cases（5 cases were right coronary distal lesions ） of missed diagnosis. Conclusion Coronary CTA is apreferred imaging ex- amination for the coronary artery disease. CTA is very helpful for the diagnosis of CHD and it can be used as screening and diagnosis of CHD patients.