摘要
目的探讨简化的Wells评分、简化Geneva评分(二水平、三水平分类方法)对急性肺栓塞住院患者临床可能性预测评估的实际应用价值。方法回顾性分析2013年1月至2015年8月于北京市大兴区人民医院住院的215例疑似急性肺栓塞患者,所有患者均进行CT肺动脉造影(computed tomographic pulmonary angiography,CTPA),并分别采用简化Wells评分和简化Geneva评分(二水平和三水平分类方法)进行评估分级,同时进行D-二聚体检测,以CTPA为确诊肺栓塞的标准,分析比较不同评分的预测价值。结果 215例患者中确诊为肺栓塞78例(36.3%)。简化Wells评分:不可能组和可能组肺栓塞的确诊率分别为32.8%和100%;简化Geneva评分(二水平分类方法):不可能组和可能组肺栓塞的确诊率分别为32.4%和57.6%;简化Geneva评分(三水平分类方法):低、中、高度可能组肺栓塞的确诊率为26.9%、45.3%、100%。简化Wells评分的受试者工作特征曲线(ROC曲线)下面积为0.5705,简化Geneva评分(二水平分类方法)为0.5707,简化Geneva评分(三水平分类方法)为0.6152,三种评分的ROC曲线下面积经比较差异无显著性(P>0.05)。而联合D-二聚体检测的敏感度高达95%。结论在对急性肺栓塞临床可能性的预测中,三种评分方法预测风险越高,则肺栓塞的确诊率越高,且三种简化评分方法的预测价值相似。对于评分低者需结合D-二聚体检查结果进行下一步的临床诊疗。
Objective To evaluate the performance of simplification of Wells and Revised Geneva Score（two and three level scores） in inpatients with suspected pulmonary embolism（PE）. Method Clinical data of 215 cases suspected acute pulmonary embolism in the People＇s Hospital of Daxing District from January 1, 2013 to August 31, 2015 was analyzed retrospectively. They all accepted a computed tomography angiography（CTPA） and a plasma D-dimer testing. Data of them were analyzed by simplification of Wells and Revised Geneva Score（two and three level scores）. The diagnosis ＂gold standard＂ was CTPA. This study will evaluate the performance of simplification of Wells and Revised Geneva Score（two and three levels scores） for the prediction value of acute pulmonary embolism in respiratory department by retrospective analysis. Result Seventy-eight pulmonary embolisms were confirmed in 215 cases suspected acute pulmonary embolism. Prevalence of PE was 36.3%. The prevalence for the simplified Wells score（PE unlikely or PE likely） was 32.8% and 100%. The prevalence of PE for two-level scores（PE unlikely or PE likely） was 32.4%, and 57.6%; low, medium and high probability of pulmonary embolism diagnosed group was 26.9%, 45.3% and 100%.ROC analysis showed that the area under curve（AUC） of simplified Wells score, Revised Geneva Score（two and three levels scores） was 0.5705. There were no significant differences in simplified Wells or Revised Geneva score（P〉0.05）. This plasma D-dimer testing sensitivity is 95%. Conclusion To evaluate the clinical probability for patients of PE, the simplification of Wells and Revised Geneva Score（two and three level scores） had similar diagnostic performance. Their predictive values are limited. However, the higher scores in all three clinical decision rules, the higher pulmonary embolisms are confirmed. D-dimer testing results of PE（unlikely or low scores） are very important and relevant to clinical practice.
出处
《中国医刊》
CAS
2016年第4期62-65,共4页
Chinese Journal of Medicine
关键词
肺栓塞
评分方法
CT肺动脉造影
D-二聚体
Pulmonary embolism
Rating method
Computed tomographic pulmonary angiography
D-dimer
