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目的探讨心磁图(Magnetocardiography,MCG)对于静息心电图表现正常或呈非特异性改变的冠心病患者的诊断价值并筛选实用的诊断指标。方法采用德国Magscan公司生产无屏蔽式MCG-7记录仪,选择平均分级(averageclassificationoftotalmaps,ACTM)、异常心磁图所占百分比(ratioofabnormalmaps,RAM)、复合心室激动指数(complexventricularexcitationindex,CVEI)以及R波与T波的最大磁场值比值(Rmax/Tmax)四个分析指标,比较冠心病组(n=140,冠状动脉造影提示至少一支冠状动脉狭窄≥70%)与对照组(n=82例,冠状动脉造影显示冠状动脉完全正常)的MCG结果。结果冠心病组异常磁图的比例达到62%,多数电流密度图无明显双极对称结构,而对照组异常磁图的比例为35%,电流密度图有明显双极对称结构。冠心病组平均分级(2.62±0.98)显著高于对照组(2.29±0.90)。冠心病组的CVEI值位于异常区域(-100~0)内,而对照组CVEI值位于正常区域内(0~100)。Rmax/Tmax的比值在冠心病组高于对照组(6.41±3.29比4.10±2.00)。上述指标两组间差异均有统计学意义(P≤0.05)。通过受试者工作特征曲线(ROC曲线)分析表明,RAM、CVEI及Rmax/Tmax的诊断价值相对较高,敏感性分别为67.1%,65.9%及64.3%。特异性分别为65.1%,68.3%及68.3%。结论MCG对于静息心电图表现正常或呈非特异性改变者的慢性心肌缺血患者有独特的诊断价值,有利于冠心病的早期诊断。
Objective To investigate the diagnostic value of Magnetocardiography (MCG) in coronary heart disease patients with normal or nonspecific resting ECG changes and to screen practical diagnostic criteria. Methods The unshielded MCG-7 recorder manufactured by Germany Magscan Company was used. The average classification ratio (ACTM), ratio of abnormal cardiac magnetic resonance (RAM), complex ventricularexcitation index (CVEI) (N = 140, coronary angiography prompted at least one coronary artery stenosis≥70%) and control group (n = 82, coronal Angiography shows complete normal coronary arteries) MCG results. Results The proportion of abnormal magnetic maps in coronary heart disease group reached 62%. Most current density maps showed no obvious bipolar symmetry, but the proportion of abnormal magnetic maps in control group was 35%. The current density map showed obvious bipolar symmetry. Coronary heart disease group average grading (2.62 ± 0.98) was significantly higher than the control group (2.29 ± 0.90). Coronary heart disease group CVEI value in the abnormal area (-100 ~ 0), while the control group CVEI value is located in the normal area (0 ~ 100). The ratio of Rmax / Tmax in coronary heart disease group was higher than that in control group (6.41 ± 3.29 vs 4.10 ± 2.00). The above indicators between the two groups were statistically significant differences (P ≤ 0.05). The receiver operating characteristic curve (ROC curve) analysis showed that the diagnostic value of RAM, CVEI and Rmax / Tmax were relatively high with sensitivity of 67.1%, 65.9% and 64.3% respectively. The specificity was 65.1%, 68.3% and 68.3% respectively. Conclusion MCG has a unique diagnostic value for patients with chronic myocardial ischemia who have normal or nonspecific resting ECG changes, which is good for the early diagnosis of coronary heart disease.