摘要
目的 探讨Padua评分联合D-dimer对呼吸内科住院患者静脉血栓栓塞症(VTE)的风险评估价值。方法 纳入179例高度疑似VTE的呼吸内科住院患者。以CTPA和/或V/Q或双下(上)肢加压静脉彩超的阳性结果作为确诊VTE的金标准,采集所有纳入患者的一般资料,包括性别、年龄、现病史、吸烟史、体重指数,均行Padua评分并收集D-dimer检测值,运用受试者工作特征曲线(ROC)分析比较Padua评分、D-dimer及二者联合对呼吸内科住院患者中VTE的风险评估价值。结果 179例呼吸内科高度疑似VTE住院患者中有83例确诊,确诊率为46.4%。一般资料中VTE组和非VTE组的Padua评分和D-dimer检测相比,差异有显著统计学意义(P<0.01)。Padua评分对其预测的ROC曲线下面积(AUC)为0.784[95%CI(0.710~0.858)],最佳临界值为3.5分,≥3.5分时灵敏度为69.9%,特异度为86.5%,Youden指数为0.563;D-dimer检测对其预测的AUC为0.898[95%CI(0.852~0.943)],最佳临界值为553μg/L,≥553μg/L时灵敏度为85.5%,特异度为82.3%,Youden指数为0.678;当Padua评分≥3.5分且D-dimer≥553μg/L对其预测的AUC为0.931[95%CI(0.895~0.967)],灵敏度为86.7%,特异度为86.5%,Youden指数为0.732。Padua评分联合D-dimer对呼吸内科疑诊VTE住院患者的灵敏度、特异度、Youden指数及AUC均较Padua评分和D-dimer有显著提高,总体预测价值明显优于两种方法单独使用时。结论 Padua评分联合D-dimer对呼吸内科住院高度疑似VTE患者的风险评估的灵敏度、特异度和诊断效能方面均优于单独使用Padua评分或D-dimer检测,能够更准确的预测VTE的发生风险,有助于临床医师早期高效的筛查出VTE患者并采取相应的治疗措施。
Objective To explore the value of the Padua score combined with D-dimer for risk assessment of venous thromboembolism(VTE) in respiratory medicine hospitalized patients.Methods A total of 179 respiratory inpatients with high VTE suspicion were included.Positive results of CTPA and/or V/Q or double lower(upper) limbs compression venous color Doppler ultrasound were used as the gold standard for diagnosis of VTE.General data of all patients were collected,including gender,age,history of present disease,smoking history,and body mass index.Padua score was performed and D-dimer test values were collected.Receiver operating characteristic curve(ROC) analysis was used to compare the value of the Padua score,D-dimer,and their combination in the risk assessment of VTE in respiratory inpatients.Results Among 179 patients with highly suspected VTE in the respiratory department,83 cases were confirmed,and the confirmed rate was 46.4%.In general data,there were statistically significant differences in Padua scores and the D-dimer test between the VTE group and the non-VTE group(P<0.01).The area under ROC curve(AUC) predicted by the Padua score was 0.784[95%CI(0.710~0.858)],the optimal critical value was 3.5 points,the sensitivity was 69.9%,the specificity was 86.5%,and the Youden index was 0.563 when Padua score was ≥3.5.The AUC predicted by D-dimer detection was 0.898[95% CI( 0.852 ~0.943) ],the optimal critical value was 553μg/L,the sensitivity was 85.5%,the specificity was 82.3%,and the Youden index was 0.678 when ≥553μg/L.When Padua score ≥3.5 and D-dimer≥553μg/L,the predicted AUC was 0.931[95% CI( 0.895 ~ 0.967) ],the sensitivity was 86.7%,the specificity was 86.5%,and the Youden index was 0.732.The sensitivity,specificity,Youden index,and AUC of the Padua score combined with the D-dimer were significantly higher than those of the Padua score and D-dimer in patients with suspected VTE in the respiratory department,and the overall predictive value was significantly better than that of the two methods alone.Conc
作者
董清
成孟瑜
DONG Qing;CHENG MengYu(Teaching department,Shanxi Bethune Hospital,Taiyuan,Shanxi 030032,China;Department of Respiratory and Critical Care Medicine,Shanxi Bethune Hospital,Taiyuan,Shanxi 030032,China)
出处
《临床肺科杂志》
2024年第4期501-506,共6页
Journal of Clinical Pulmonary Medicine
基金
山西省留学人员科技活动择优资助项目(No.20200029)。
