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目的探究联合应用缺血修饰白蛋白(IMA)与二维斑点追踪技术(2D-STI)早期诊断不稳定型心绞痛(UA)的临床意义。方法根据冠脉造影结果选取山西医科大学第一医院心内科2014年9月至2016年9月收治的118例左前降支单一病变且狭窄程度≥70%并行经皮冠状动脉介入治疗(PCI)治疗的UA患者(PCI组)以及78例冠脉无狭窄的患者(对照组),两组术中记录胸痛症状及常规12导联心电图,分别于术前及术后检测IMA、行超声心动图检查。应用2D-STI技术计算左室整体纵向应变(GPLS)。数据采用SPSS 19.0统计学软件进行分析处理。结果PCI组术前IMA、GPLS与对照组术前比较差异无统计学意义(P>0.05);PCI组术后IMA、GPLS与对照组术前比较差异无统计学意义(P<0.05);PCI组术前术后IMA、GPLS差异有统计学意义(P<0.05);对照组术前术后IMA、GPLS差异无统计学意义(P>0.05)。IMA、GPLS(2D-STI)单项检测PCI组术后心肌缺血的敏感度分别为85.22%、66.96%,特异度分别为65.38%、74.36%;IMA联合GPLS(2D-STI)检测PCI组术后心肌缺血的敏感度为64.35%,特异度为93.59%;联合检测特异度明显高于单项检测,差异有统计学意义(P<0.05)。结论 IMA联合2D-STI有利于UA的早期诊断,可为临床UA诊断提供参考依据。
Objective To investigate the clinical significance of early diagnosis of unstable angina pectoris (UA) combined with IMA-2D and 2D-STI. Methods According to the results of coronary angiography, 118 patients with single left anterior descending coronary artery were treated in Department of Cardiology, First Hospital of Shanxi Medical University from September 2014 to September 2016 and were treated with percutaneous coronary intervention (PCI) with stenosis ≥70% Of UA patients (PCI group) and 78 patients with coronary artery stenosis (control group). Two groups of intraoperative records of chest pain symptoms and conventional 12-lead electrocardiogram were used to detect IMA before and after surgery respectively. Echocardiography . The left ventricular longitudinal strain (GPLS) was calculated using 2D-STI technique. Data were analyzed by SPSS 19.0 statistical software. Results There was no significant difference in the preoperative IMA, GPLS and control group before operation in PCI group (P> 0.05). There was no significant difference in the preoperative value between IMA and GPLS in PCI group and PCI group (P <0.05) The preoperative and postoperative IMA, GPLS difference was statistically significant (P <0.05); control group preoperative and postoperative IMA, GPLS difference was not statistically significant (P> 0.05). The sensitivities of IMA and GPLS (2D-STI) to single-slice PCI were 85.22% and 66.96% respectively, and the specificity were 65.38% and 74.36% respectively. The 2D-STI and IMA-GPLS The sensitivity of myocardial ischemia was 64.35% and the specificity was 93.59%. The specificity of combined detection was significantly higher than that of single detection (P <0.05). Conclusion IMA combined with 2D-STI is helpful for the early diagnosis of UA, which can provide a reference for clinical UA diagnosis.