运动平板试验在胸外科术前筛查冠状动脉粥样硬化性心脏病的应用及意义

Application and significance of treadmill exercise test for screening of coronary heart disease before thoracic surgery

摘要:

目的  回顾性研究运动平板试验（TET）在胸外科非心脏病患者术前筛查冠状动脉粥样硬化性心脏病（CHD）的应用及意义。方法  2009年1月-2013年10月中南大学湘雅二医院胸外科住院的TET异常的336例患者，进行冠状动脉造影（CAG）作为诊断CHD的金标准。比较TET阳性组和可疑阳性组的CHD阳性预测值以及不同年龄、性别、是否合并高血压、糖尿病等对TET阳性预测值的影响。结果  336例患者中，男性252例（75%），女性84例（25%）；平均年龄（59.77±7.92）岁。TET阳性组对CHD的阳性预测值高于可疑阳性组（36.36% vs 23.04%，P =0.008）；TET老年组（年龄≥60岁）的CHD阳性预测值高于中年组（年龄<60岁）（40.35% vs 15.76%，P =0.000）；TET男性组高于女性组（31.35% vs 19.05%，P =0.030）；高血压组的CHD阳性预测值高于非高血压组（57.69% vs 22.89%，P =0.000）；糖尿病组CHD阳性预测值高于非糖尿病组（62.07% vs 25.08%，P=0.000），各组差异有统计学意义。结论  TET可作为术前CHD常规筛查手段以评估手术风险，指导制订围手术期的治疗方案。TET阳性较可疑阳性具有更高的CHD阳性预测值。老年人较中年人、男性较女性、高血压或糖尿病较无高血压或无糖尿病的TET阳性预测值高。

Abstract:

Objective To retrospectively study the application and significance of preoperative screening of coronary heart disease (CHD) by treadmill exercise test (TET) for patients with thoracic non-heart diseases. Methods A total of 336 cases whose TET was positive or suspected positive from January 2009 to October 2013 in the Department of Thoracic Surgery in the Second Xiangya Hospital of Central South University were selected. All of them underwent coronary angiography (CAG) as the gold standard for diagnosis of CHD. Positive predictive value for CHD was compared between the positive-TET group and the suspicious-positive-TET group. Effects of age, gender, hypertension and diabetes on positive predictive value of CHD were examined. Results There were 252 males (75%) and 84 females (25%). The average age was (59.77 ± 7.92) years. The positive predictive value of CHD in the positive-TET group was higher than that in the suspicious-positive-TET group (36.36% vs 23.04%, P = 0.008). The positive predictive value in the older group (aged ≥ 60 years) was higher than that in the middle-aged group (age < 60 years) (40.35% vs 15.76%,  P = 0.000). The positive predictive value in the male group was higher than that in the female group (31.35% vs 19.05%, P = 0.030). The positive predictive value in the hypertension group was higher than that in the non-hypertension group (57.69% vs 22.89%, P = 0.000). The positive predictive value of the diabetic group was higher than that in the non-diabetic group (62.07% vs 25.08%, P = 0.000). The differences were statistically significant. Conclusions TET can be a routine preoperative screening method for CHD to assess the risk of surgery and guide peri-operative treatment. Compared with suspicious positive TET, positive TET has higher positive predictive value. TET has a higher positive predictive value for CHD in old-aged patients, the male and the cases with hypertension or diabetes than in middle-aged patients, the female and the cases without hypertension or diabetes.