Philbrick J T, Horwitz R I, Feinstein A R
Am J Cardiol. 1980 Nov;46(5):807-12. doi: 10.1016/0002-9149(80)90432-4.
To determine why exercise testing remains controversial as a diagnostic test for coronary artery disease, a methodologic review was undertaken of 33 studies comprising 7,501 patients who had undergone both exercise tests and coronary angiography. Of seven methodologic standards for research design, only one received general compliance: the requirement for an adequate variety of anatomic lesions. Less than half of the studies complied with any of the remaining six standards: adequate identification of the groups selected for study; adequate analysis for relevant chest pain syndromes; avoidance of a limited challenge group; and avoidance of work-up bias, diagnostic review bias and test review bias. Only one study met as many as five standards. These methodologic problems may explain the wide range of sensitivity (35 to 88 percent) and specificity (41 to 100 percent) found for exercise testing, because the variations could not be attributed to the usual explanations: definition of anatomic abnormality, stress test technique or definition of an abnormal test. Determining the true value of exercise testing requires methodologic improvements in patient selection, data collection and data analysis.
为了确定运动试验作为冠心病诊断试验为何仍存在争议，我们对33项研究进行了方法学综述，这些研究共纳入了7501例既接受了运动试验又接受了冠状动脉造影的患者。在研究设计的七项方法学标准中，只有一项得到了普遍遵守：对各种解剖病变的充分要求。不到一半的研究符合其余六项标准中的任何一项：对所选研究组的充分识别；对相关胸痛综合征的充分分析；避免有限的挑战组；避免检查偏倚、诊断复查偏倚和试验复查偏倚。只有一项研究符合多达五项标准。这些方法学问题可能解释了运动试验中广泛的敏感性（35%至88%）和特异性（41%至100%），因为这些变化不能归因于通常的解释：解剖异常的定义、压力测试技术或异常测试的定义。确定运动试验的真正价值需要在患者选择、数据收集和数据分析方面进行方法学改进。
