中华老年多器官疾病杂志
中華老年多器官疾病雜誌
중화노년다기관질병잡지
CHINESE JOURNAL OF MULTIPLE ORGAN DISEASES IN THE ELDERLY
2015年
4期
287-291
,共5页
老年人%肺栓塞%改良Geneva量表%血浆D-二聚体
老年人%肺栓塞%改良Geneva量錶%血漿D-二聚體
노년인%폐전새%개량Geneva량표%혈장D-이취체
elderly%pulmonary embolism%revised Geneva score%plasma D-dimer
目的：评价改良Geneva量表及其联合血浆D?二聚体对老年患者肺栓塞（PE）的快速床旁诊断及排除价值。方法2009年1月至2014年4月在北京大学人民医院因胸痛、呼吸困难等症状被疑诊PE的患者276例，分为老年组（≥60岁）和非老年组（＜60岁），以CT肺动脉造影（CTPA）为确诊金标准。按照改良Geneva量表分为PE低度可能性、中度可能性及高度可能性，同时检测血浆D?二聚体。分析两组患者临床特征，比较改良Geneva量表、血浆D?二聚体、改良Geneva量表联合血浆D?二聚体在两组患者中的诊断及排除诊断价值，其诊断预测价值用受试者工作特征（ROC）曲线下面积（AUC）进行评价。结果276例疑诊PE患者，经CTPA确诊PE 80例（≥60岁52例，＜60岁28例）。运用ROC曲线评价改良Geneva量表对PE的诊断价值，老年组与非老年组AUC分别为0.974（95% CI：0.940～0.992），0.981（95% CI：0.924～0.998），差异有统计学意义（P＜0.001）。老年组血浆D?二聚体、改良Geneva量表联合血浆D?二聚体诊断PE的阴性预测值分别为93.8%，100.0%；非老年组分别为88.9%，100.0%。结论老年PE患者临床特征不典型；改良Geneva量表对老年PE患者的诊断价值低于非老年患者；对于老年及非老年疑诊PE患者，改良Geneva量表联合血浆D?二聚体均可安全排除PE，其价值优于单独检测血浆D?二聚体。
目的：評價改良Geneva量錶及其聯閤血漿D?二聚體對老年患者肺栓塞（PE）的快速床徬診斷及排除價值。方法2009年1月至2014年4月在北京大學人民醫院因胸痛、呼吸睏難等癥狀被疑診PE的患者276例，分為老年組（≥60歲）和非老年組（＜60歲），以CT肺動脈造影（CTPA）為確診金標準。按照改良Geneva量錶分為PE低度可能性、中度可能性及高度可能性，同時檢測血漿D?二聚體。分析兩組患者臨床特徵，比較改良Geneva量錶、血漿D?二聚體、改良Geneva量錶聯閤血漿D?二聚體在兩組患者中的診斷及排除診斷價值，其診斷預測價值用受試者工作特徵（ROC）麯線下麵積（AUC）進行評價。結果276例疑診PE患者，經CTPA確診PE 80例（≥60歲52例，＜60歲28例）。運用ROC麯線評價改良Geneva量錶對PE的診斷價值，老年組與非老年組AUC分彆為0.974（95% CI：0.940～0.992），0.981（95% CI：0.924～0.998），差異有統計學意義（P＜0.001）。老年組血漿D?二聚體、改良Geneva量錶聯閤血漿D?二聚體診斷PE的陰性預測值分彆為93.8%，100.0%；非老年組分彆為88.9%，100.0%。結論老年PE患者臨床特徵不典型；改良Geneva量錶對老年PE患者的診斷價值低于非老年患者；對于老年及非老年疑診PE患者，改良Geneva量錶聯閤血漿D?二聚體均可安全排除PE，其價值優于單獨檢測血漿D?二聚體。
목적：평개개량Geneva량표급기연합혈장D?이취체대노년환자폐전새（PE）적쾌속상방진단급배제개치。방법2009년1월지2014년4월재북경대학인민의원인흉통、호흡곤난등증상피의진PE적환자276례，분위노년조（≥60세）화비노년조（＜60세），이CT폐동맥조영（CTPA）위학진금표준。안조개량Geneva량표분위PE저도가능성、중도가능성급고도가능성，동시검측혈장D?이취체。분석량조환자림상특정，비교개량Geneva량표、혈장D?이취체、개량Geneva량표연합혈장D?이취체재량조환자중적진단급배제진단개치，기진단예측개치용수시자공작특정（ROC）곡선하면적（AUC）진행평개。결과276례의진PE환자，경CTPA학진PE 80례（≥60세52례，＜60세28례）。운용ROC곡선평개개량Geneva량표대PE적진단개치，노년조여비노년조AUC분별위0.974（95% CI：0.940～0.992），0.981（95% CI：0.924～0.998），차이유통계학의의（P＜0.001）。노년조혈장D?이취체、개량Geneva량표연합혈장D?이취체진단PE적음성예측치분별위93.8%，100.0%；비노년조분별위88.9%，100.0%。결론노년PE환자림상특정불전형；개량Geneva량표대노년PE환자적진단개치저우비노년환자；대우노년급비노년의진PE환자，개량Geneva량표연합혈장D?이취체균가안전배제PE，기개치우우단독검측혈장D?이취체。
Objective To evaluate the clinical diagnostic and exclusive values of revised Geneva score and its combination with plasma level of D-dimer for suspected pulmonary embolism (PE) in the elderly patients. Methods A total of 276 patients with suspected PE due to chest pain and dyspnea admitted in our hospital from January 2009 to April 2014 were enrolled in this study. They were divided into 2 groups based on their age, that is, the aged group (≥60 years old) and the non-aged group (<60 years old). Computed tomography pulmonary arteriography (CTPA) was considered as the gold standard for diagnosis. According to the revised Geneva score, the diagnosis of PE was categoried into different clinical probability, ie, low, medium and high probability, and their plasma level of D-dimer was also tested. Based on their clinical features, the diagnostic values of revised Geneva score, the exclusive values of plasma D-dimer, and that of combining revised Geneva score with D-dimer together were analyzed between the 2 groups. The receiver operating characteristics (ROC) curve was used to evaluate the overall accuracy of revised Geneva score in the diagnosis of PE. Results Among the cohort with suspected PE, 80 cases were definitely diagnosed as PE by CTPA (52 cases ≥60 years old, and 28 cases <60 years old). The area under the ROC curve (AUC) was 0.974 (95% CI: 0.940?0.992) for the aged group and 0.981 (95% CI:0.924?0.998)for the non-aged one, with significant difference between them (P<0.001). The negative predictive values of D-dimer, and the revised Geneva score combined with D-dimer were 93.8% and 100.0% respectively for the aged patients, and 88.9% and 100.0% for the non-aged patients. Conclusion The clinical features of PE are atypical in the elderly patients. The revised Geneva score has lower diagnostic value for the aged than the non-aged patients. Combination of revised Geneva score and plasma level of D-dimer is a safe strategy to rule out PE and is better than D-dimer alone for the aged and non-aged patients with suspected PE.
