Brandimarte C, Battista M, Galiè M, Delfino M
Dipartimento di Medicina Clinica, Università La Sapienza, Roma.
Recenti Prog Med. 1996 Nov;87(11):564-70.
Chest pain, one of the cardinal manifestations of cardiovascular disease, is a symptom of many other diseases. The diagnosis of coronary artery disease is often difficult to relieve on history and physical examination, so many sophisticated tests have been developed to allow an early and more accurate diagnosis. Physicians must decide the appropriate indications and strategies to correctly utilize different non-invasive diagnostic tests, in order to minimize the risks and maintain the cost effectiveness of their decisions. The Bayes' theorem can be utilized to calculate the probability of coronary artery disease starting from clinical data and multiple non-invasive tests results. This is a mathematical method by which the results of the different tests can be integrated into a quantitative statement of the post-test probability of coronary artery disease to reach a more accurate final prediction of the chance of disease. The prevalence of the pre-test probability of disease can be determined in every patient from informations readily obtained by clinical evaluation, in accordance with the data of the Framingham and other studies. The post-test likelihood of disease depends on the sensitivity and specificity of the test: this estimate, before any test is performed, is crucial both for further decisions on the need for other tests and for determining the final likelihood of coronary artery disease.
胸痛是心血管疾病的主要表现之一，也是许多其他疾病的症状。冠心病的诊断往往难以仅通过病史和体格检查来确定，因此已经开发了许多精密的检查来实现早期且更准确的诊断。医生必须确定适当的指征和策略，以正确使用不同的非侵入性诊断检查，从而将风险降至最低并保持决策的成本效益。贝叶斯定理可用于根据临床数据和多项非侵入性检查结果计算冠心病的概率。这是一种数学方法，通过该方法可以将不同检查的结果整合为冠心病检查后概率的定量表述，以得出对疾病发生几率更准确的最终预测。根据弗雷明汉及其他研究的数据，通过临床评估容易获得的信息，可以为每位患者确定疾病检查前概率的患病率。检查后疾病的可能性取决于检查的敏感性和特异性：在进行任何检查之前进行的这种评估，对于进一步决定是否需要进行其他检查以及确定冠心病的最终可能性都至关重要。
