腺苷和运动试验201T1心肌灌注显像诊断女性冠心病价值比较

目的对比腺苷试验和运动试验201T1心肌灌注显像诊断女性冠心病的价值。方法采用随机对照研究，观察138例女性冠心病疑似病例，按随机数字表法将其分为腺苷试验组和运动试验组，每组69例，分别进行201T1心肌灌注显像，并在1周内行冠状动脉造影检查。负荷心肌灌注显像按心肌缺血严重程度与缺血范围分析，冠状动脉造影按主要血管狭窄程度（〉50％为冠心病）分析。以冠状动脉造影结果为“金标准”，比较腺苷和运动试验对女性冠心病的诊断灵敏度、准确性、阴性预测值和假阳性率。2组间比较采用x2检验或确切概率法。结果腺苷试验方法对女性冠心病诊断的灵敏度、阴性预测值、准确性分别为88．2％（45／51）、72．7％（16／22）和88．4％（61／69）；运动试验组分别为91．7％（44／48）、66．7％（8／12）和81．2％（52／64），二者间差异无统计学意义（x2=0．571，n714，0．249，P〉0．05）。腺苷试验组假阳性率低于运动试验组11．1％（2／18）与50．0％（8／16），P=0．023]。结论对于女性冠心病患者，腺苷试验心肌灌注显像与运动试验心肌灌注显像同样有效，且腺苷试验的诊断假阳性率低。

Comparison of adenosine and exercise stress 201T1 myocardial perfusion imaging for diagnosing coronary heart disease in women

Objective To compare the diagnostic value of adenosine and exercise stress myocardial perfusion imaging （MPI） for detecting coronary heart disease （CHD） in women. Methods One hundred and thirty-eight patients with CHD were randomly divided into two groups ： adenosine stress group （ n = 69） and exercise stress group （n = 69）. All patients underwent myocardial SPECT evaluation. Coronary angiography （ CAG）, referred as ＂ gold standard＂, was performed in each patient within 1 week before or after MPI. The diagnostic value of the two stress MPI was compared withx2 test or Fisher＇s exact test. Results In adenosine stress group, the sensitivity, negative predictive value and accuracy were 88.2% （45/51）, 72.7% （ 16/22）, 88.4% （61/69）, respectively, which were not significantly different from those of the exercise stress group （91.7% （44/48）, 66.7% （8/12）, 81.2% （52/64） ; X2 =0. 571,0.714, 0.249, P 〉 0.05 ）. However, the false positive rate of adenosine stress （11.1%, 2/18 ） was significantly lower than that of exercise stress （50.0%, 8/16）, P = 0.023. Conclusions Adenosine and exercise stress MPI have similar value for CHD diagnosis in women, however, adenosine stress MPI may have an advantage of low false positive rate.