摘要
目的评估完整下肢深静脉加压超声检查(CUS)诊断急性肺栓塞(PE)的准确性。方法收集2017年1月至11月疑似急性PE住院患者196例,进行D-二聚体检测、完整CUS和计算机断层肺血管造影(CTPA)检查。结果确诊PE 53例(27.0%),完整CUS发现DVT患者74例(37.8%)。近端DVT 18例(9.2%),其中非PE组5例(3.5%,5/143),PE组13/53例(24.5%,13/53)。孤立性远端DVT 56例(28.6%),非PE组29例(20.3%,29/143),PE组27例(50.9%,27/53)。近端CUS诊断PE的敏感性为24.53%(14.19%~38.58%),特异性为96.50%(91.61%~98.71%),阳性预测值72.22%(46.41%~89.29%),阴性预测值77.53%(70.55%~83.29%)、阳性似然比7.02%(2.63%~18.73%),阴性似然比0.78%(0.67%~0.91%)。完整CUS诊断PE的敏感性为75.47%(61.42%~85.81%),特异性为76.22%(68.24%~82.76%),阳性预测值54.05%(42.13%~65.56%),阴性预测值89.34%(82.13%~93.39%),阴性似然比3.17%(2.28%~4.42%),阴性似然比0.32%(0.20%~0.52%)。完整CUS诊断PE的敏感性明显高于近端CUS,特异性明显低于近端CUS,差异均有统计学意义(P<0.001)。结论近端CUS敏感性低,不能用来排除PE,完整CUS可明显提高诊断PE的敏感性,值得在可疑急性PE患者中推广应用。
Objective To investigate the application value of complete lower limb deep vein compression ultrasonography(CUS)in diagnosis of acute pulmonary embolism(PE).Methods A total of 210 patients with suspected acute PE who were admitted nd treated in our hospital from January 2017 to November 2017 were enrolled in the study.The complete CUS was performed by independent operators,and D-dimer assay and Computer tomography pulmonary angiography(CTPA)performed to assess independently and blindly the disease condition of patients.Results The complete CUS showed that there were 74 cases(37.8%)of DVT,of whom,there were 18 cases(9.2%)of proximal DVT,including 5 cases(3.5%)in non-PE group and 13 cases(24.5%)in PE group.There were 56 cases(28.6%)of isolated distal DVT,including 29 cases(20.3%)in non-PE group and 27 cases(50.9%)in PE group.The diagnostic sensitivity of proximal CUS in diagnosis of PE was 24.53%(14.19%~38.58%),specificity was 96.50%(91.61%~98.71%),and positive predictive value was 72.22%(46.41%~89.29%),negative predictive value was 77.53%(70.55%~83.29%),positive likelihood ratio was 7.02%(2.63%~18.73%),negative likelihood ratio was 0.78%(0.67%~0.91%).The diagnostic sensitivity of complete CUS in diagnosis of PE was 75.47%(61.42%~85.81%),specificity was 76.22%(68.24%~82.76%),positive predictive value was 54.05%(42.13%~65.56%),negative predictive value was 89.34%(82.13%~93.39%),positive likelihood ratio was 3.17%(2.28%~4.42%),negative likelihood ratio was 0.32%(0.20%~0.52%).The sensitivity of complete CUS in diagnose PE was significantly higher than that by proximal CUS,however,the specificity was significantly lower than that by proximal CUS(P<0.01).Conclusion The proximal CUS has lower sensitivity in diagnosis of PE,however,the complete CUS can improve the sensitivity in diagnosis of PE,therefor,which is worthy of clinical application and promotion.
作者
刘翠景
靳占义
赵雅培
谢迎新
张立建
赵艳琴
王岳恒
杨翠英
LIU Cuijing;JIN Zhanyi;ZHAO Yapei(Department of Ultrasonography,East Branch of The Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China;不详)
出处
《河北医药》
CAS
2020年第22期3401-3404,共4页
Hebei Medical Journal
关键词
下肢深静脉加压超声检查
深静脉血栓形成
肺栓塞
静脉血栓栓塞症
CT肺动脉造影
lower limb deep venous compressive venous ultrasonography
deep venous thrombosis
pulmonary embolism
venous thromboembolism
computer tomography pulmonary angiography
