摘要目的 分析运动负荷试验（exercise stress test，EST）及其相关参数对冠心病的诊断价值，并探讨个体因素[年龄、性别、体重指数（body mass index, BMI）]对其诊断准确性的影响。方法 选取行平板或踏车运动试验且行冠状动脉(简称冠脉)造影的患者439例，其中阳性患者318例，阴性患者121例，观察EST结果的敏感性与特异性。根据年龄、性别、BMI及造影阳性病例病变血管支数、是否包括左主干和（或）左前降支近段病变、是否出现室性心律失常，对所有入选患者进行分组。分析各组EST参数对冠心病确诊的参考价值。结果 EST诊断冠心病的敏感性81.22%，特异性34.71%；冠脉多支血管病变组真阳性率明显高于单支血管病变组（88.12% vs. 73.96%，P=0.011），假阴性率低于单支血管病变组（11.88% vs. 26.04%，P=0.011）；与非左主干和（或）左前降支近段病变组比较，冠脉左主干和（或）左前降支近段病变组真阳性率差异无统计学意义（76.92% vs. 86.02%，P=0.103）；EST真阳性组运动中峰值心率，目标心率达标率及恢复1、2 min心率均低于假阳性组（P＜0.05），而真阳性病例中单支血管病变组运动中峰值心率，目标心率达标率及恢复1、2 min心率均高于多支血管病变组（P＜0.05）；真阳性组室性心律失常发生率明显高于假阳性组（63.06% vs. 18.02%，P=0.048）和假阴性组（63.06% vs. 7.21%，P=0.046）。结论 EST对冠心病有一定的诊断价值，高龄，男性，超重，运动中峰值心率，目标心率达标率及恢复1、2 min心率均异常，且出现室性心律失常的患者，当EST为阳性时，应进一步完善冠脉造影检查。对于高度怀疑冠心病且EST结果阴性的患者，应综合分析相关个体因素。
Abstract： Objective To analyze the value of exercise stress test (EST) and related parameters on diagnosing coronary heart disease (CHD), and to explore the influence of individual factors [such as age, sex and body mass index(BMI)] on its diagnostic accuracy. Methods We selected 439 patients who had performed treadmill or bicycle exercise test and coronary angiography (CAG). There were 318 CAG positive patients and 121 negative cases among those patients. The sensitivity and specificity of their EST results were observed. All the enrolled patients were grouped according to age, sex, BMI, the number of lesioned vessels, the lesioned vessels whether including the left main artery (LM) and(or) the proximal branch of the left anterior descending artery (LAD1), and the presence or absence of ventricular arrhythmias. The reference value of EST parameters on the definite diagnosis of CHD was analyzed in each group.Results The sensitivity and specificity of EST in diagnosing CHD is separately 81.22% and 34.71%. The true positive rate of the multibranch coronary artery lesion group is significantly higher than that of the singlebranch vascular lesion group (88.12% vs. 73.96%, P=0.011), however its false negative rate is lower than that of the singlebranch vascular lesion group (11.88% vs. 26.04%, P=0.011). The true positive rate of the LM and(or) LAD1 lesion group does not vary significantly from that of the nonLM and(or) LAD1 lesion group (76.92% vs. 8602%, P=0.103). In the EST true positive group, the peak heart rate (HR) during exercise, attainment rate of target HR, and 1 and 2 min HR during the recovery period are all lower than those in the false positive group (P＜0.05). Among the true positive cases, the peak HR during exercise, attainment rate of target HR, and 1 and 2 min HR during the recovery period of the singlebranch vascular lesion group are all higher than those of the multibranch coronary artery lesion group (P＜0.05). The incidence of ventricular arrhythmias of the true positive group is significantly higher than that of the false positive group (63.06% vs. 18.02%, P=0.048) and the false negative group (63.06% vs. 7.21%, P=0.046). Conclusion EST has some diagnostic value for CHD. For the elderly overweight males with abnormal peak HR during exercise, attainment rate of target HR, and 1 and 2 min HR during the recovery period, and with ventricular arrhythmias, positive EST results suggest further CAG examination. For the patients with high suspicion of CHD and negative EST results, the related individual factors should be comprehensive analyzed.
