两种无创方法筛选更年期女性患者冠心病的价值

目的探讨动态心电图与运动平板试验对诊断有心血管紊乱症状更年期女性合并冠心病患者的价值,比较其优劣。方法选择400例45-55岁临床有胸闷、胸痛、心悸症状临床拟诊更年期综合征的女性患者,均行动态心电图检查及平板运动试验检查,动态心电图阳性且心肌缺血总负荷≥60mm.min及运动平板试验阳性患者再行冠状动脉造影检查,以冠状动脉造影结果作为金标准,比较其阳性率。结果 400例拟诊更年期综合征的女性患者中,平板运动试验阳性共51例,其中冠脉造影阳性者13例,阴性者38例,阳性率25.4%。动态心电图阳性且心肌缺血总负荷≥60mm.min112例,其中冠脉造影阳性28例,阴性84例,阳性率25.0%,与平板运动试验比较,阳性率差异无统计学意义（P〉0.05）。平板运动试验阳性与动态心电图阳性且心肌缺血总负荷≥60mm.min43例,其中冠脉造影阳性者29例,阴性者14例,阳性率67.4%,与单项阳性率比较,阳性率差异有统计学意义（P〈0.05）。结论运动平板试验阳性与动态心电图阳性联合心肌缺血总负荷≥60mm.min筛选更年期女性合并冠心病者,其阳性率较单项检查高,可作为无创检查诊断更年期女性冠心病的重要方法 。

Two kinds of non - invasive methods in the value of screening menopausal women with coronary heart disease

Objective To investigate the dynamic ECG and exercise stress test in the value of screening menopausal women with coronary heart disease.Methods 400 menopausal women,aged 45-55 years,with clinical dyspnea,chest pain,palpitations were diagnosed as climacteric syndrome,and performed Holter and treadmill exercise test examination.Holter-positive and ischemia burden ≥ 60 mm.min,and exercise treadmill test-positive patients performed re-coronary angiography,and the result of coronary angiography was regarded as the gold standard.Results Among 400 cases with climacteric syndrome,treadmill exercise testing was positive in 51 cases,of which 13 cases of coronary angiography-positive and negative in 38 cases,and the positive rate was 25.4%.There are 112 cases with Holter-positive and the total ischemic burden ≥ 60 mm.min,of which 28 patients with positive coronary angiography,negative in 84 cases,and the positive rate was 25.0%.There was no significant difference between the positive rate of the treadmill exercise test and Holter.There were 43 cases with treadmill exercise test positive and dynamic ECG-positive and ischemia burden ≥ 60 mm.min,of which 29 patients with positive coronary angiography,and negative in 14 cases,and the positive rate was 67.4%.Compared with the single-positive rate,the combination-positive rate had a significant difference（P0.05）.Conclusion Exercise stress test positive and dynamic ECG-positive combined with ischemia burden ≥ 60 mm·min can screen menopausal women with coronary heart disease,and their positive rate was higher than that of the individual check,and hence can be used as non-invasive diagnosis for coronary artery disease in climacteric women.