冠心病患者平板运动试验中的血压反应及其临床应用价值

目的研究冠状动脉粥样硬化性心脏病(冠心病)患者平板运动试验中的血压反应,探讨舒张压增量作为运动平板试验阳性的辅助诊断依据的临床应用价值。方法选取2015年3月至2018年11月在南京医科大学附属老年医院进行平板运动试验(treadmill exercise testing,TET)检查的患者142例,根据患者有无冠心病及原发性高血压(高血压)分为单纯冠心病组40例、单纯高血压组50例和健康对照组52例,记录患者在TET中的血压变化。结果冠心病组患者与健康对照组之间的收缩压增量比较,差异无统计学意义(P>0.05);高血压组患者与健康对照组之间的收缩压增量比较,差异有统计学意义(P<0.05)。冠心病组患者与健康对照组的舒张压增量比较,差异有统计学意义(P<0.05);高血压组患者和健康对照组的舒张压增量比较,差异无统计学意义(P>0.05)。将舒张压增量作为冠心病的预测因子,结果显示TET中舒张压增量与冠心病之间显著相关。利用受试者工作特征曲线(receiver operating characteristic curve,ROC)描绘出的舒张压增量界值为5.5 mmHg(1 mmHg=0.133 kPa),其敏感性为0.850,特异性为0.615,曲线下面积为0.713。结论选取舒张压增量为5.5 mmHg在协助诊断冠心病方面具有一定的准确性,在辅助TET可疑阳性的患者诊断冠心病时有一定的临床应用价值。

Blood pressure response in treadmill exercise test in patients with coronary heart disease and its clinical application value

Objectives To study the blood pressure response in patients with coronary heart disease during treadmill exercise test(TET),and to explore the clinical application value of diastolic blood pressure increment as a secondary diagnostic basis for positive result during TET.Methods A total of 142 patients underwent TET from March 2015 to November 2018 in Geriatric Hospital of Nanjing Medical University were selected.According to the patients with or without coronary heart disease and hypertension,the patients were divided into coronary heart disease group(n=40),hypertension group(n=50)and healthy control group(n=52).Blood pressure changes of the patients during TET were recorded.Results There was no statistically significant difference in systolic blood pressure increment between coronary heart disease group and control group(P>0.05).There was a statistically significant difference in systolic blood pressure increment between hypertension group and control group(P<0.05).There was a statistically significant difference in dia?stolic blood pressure increment between coronary heart disease group and control group(P<0.05).There was no statistically significant difference in diastolic blood pressure increment between hypertension group and control group(P>0.05).Taking diastolic blood pressure increment as a predictor of coronary heart disease,the results showed a significant correla?tion between diastolic blood pressure increment duiring TET and coronary heart disease.The diastolic blood pressure increment cut-off value plotted by receiver operating characteristic curve(ROC)was 5.5 mmHg(1 mmHg=0.133 kPa)with a sensitivity of 0.850,a specificity of 0.615,and an area under the curve of 0.713.Conclusions Diastolic blood pressure increment of 5.5 mmHg has a certain accuracy in assisting diagnosis of coronary heart disease.It has a certain clinical application value in helping to diagnose coronary heart disease in patients with suspected positive result in TET.