CAJ | 학술논문

目的：为减少肺栓塞误诊漏诊，探讨并应用受试者工作特征曲线（ receiver operator characteristic curve ， ROC曲线），比较改良Geneva评分和Wells评分系统对肺栓塞的预测价值。方法选择临床疑似诊断为肺栓塞并接受经CT肺动脉造影（ CTPA）检查的患者637例，确诊肺栓塞256例，临床医师用Wells评分和改良Geneva评分对患者进行临床评分，应用ROC曲线比较两种评分法对肺栓塞的预测价值。结果 Wells评分＜2分肺栓塞可能性为7．7％，2～6分为57．3％，＞6分为83．3％；改良Geneva评分0～3分肺栓塞可能性12．1％，4～10分为46．6％，≥11分为60．0％。 Wells评分预测肺栓塞的ROC曲线下面积（AUC）0．849（95％Cl：0．817～0．881），最佳分界值2．75分；改良Geneva 评分ROC的AUC为0．813（95％Cl：0．778～0．849），最佳分界值6．5分；两条曲线所对应AUC的差异有统计学意义（ P ＜0．05）。结论 Wells评分和改良Geneva评分对肺栓塞的预测均具有较高的临床价值；Wells评分的敏感性和特异性优于改良Geneva评分。
목적：위감소폐전새오진루진，탐토병응용수시자공작특정곡선（ receiver operator characteristic curve ， ROC곡선），비교개량Geneva평분화Wells평분계통대폐전새적예측개치。방법선택림상의사진단위폐전새병접수경CT폐동맥조영（ CTPA）검사적환자637례，학진폐전새256례，림상의사용Wells평분화개량Geneva평분대환자진행림상평분，응용ROC곡선비교량충평분법대폐전새적예측개치。결과 Wells평분＜2분폐전새가능성위7．7％，2～6분위57．3％，＞6분위83．3％；개량Geneva평분0～3분폐전새가능성12．1％，4～10분위46．6％，≥11분위60．0％。 Wells평분예측폐전새적ROC곡선하면적（AUC）0．849（95％Cl：0．817～0．881），최가분계치2．75분；개량Geneva 평분ROC적AUC위0．813（95％Cl：0．778～0．849），최가분계치6．5분；량조곡선소대응AUC적차이유통계학의의（ P ＜0．05）。결론 Wells평분화개량Geneva평분대폐전새적예측균구유교고적림상개치；Wells평분적민감성화특이성우우개량Geneva평분。
Objective To reduce misdiagnosis and underdiagnosis rates of pulmonary embolism ,the prediction of the Wells score and revised Geneva score for pulmonary embolism were compared and analyzed by receiver operating characteristic curves .Meth-ods Six hundred and thirty-seven cases with suspected pulmonary embolism ( PE) were collected ,among whom 256 cases with PE were clinically confirmed .Before CTPA test or on condition that test results were unknown ,clinical scoring was assessed prospectively by the Wells score and the Revised Geneva score .ROC curves was used to evaluate the probability of PE predicted by the Wells and the re -vised Geneva scores.Results The prevalence of PE was 7.7% with a low clinical probability (Wells Score<2 points).The preva-lence of PE was 57.3%with intermediate probability(2-6 points)and 83.3%with high probability( >6 points).The confirmed PE was 12.1%with a low probability(Geneva score 0-3 points),46.6% in intermediate probability(4-10 points),60.0% in high probability(score≥11 points).The area under curve (AUC) of the ROC curve in the Wells and Geneva scores was 0.849(95%Cl:0.817-0.881) and 0.813(95%Cl:0.778-0.849).Optimal cut off value was 2.75 points in the Wells Score and 6.5 points in the Geneva score .The comparison of the area under curve between the Wells and the Geneva score had a statistically signifcant difference ( P <0.05).Conclusion The Wells score and the revised Geneva score are valuable in prediction of pulmonary embolism .The Wells score is generally superior to the revised Geneva score .