CAJ | 학술논문

目的评价Wells评分联合D-dimer在急性肺栓塞诊断的临床预测价值.方法收集2008年至2011年就诊北京朝阳医院急诊科疑似肺栓塞患者540例,以CTPA检查阳性为确诊肺栓塞的依据,分为肺栓塞(PE)组与非肺栓塞(Non-PE)组,对两组患者在人口学特征、基础疾病、主诉、体征、静脉血栓危险因素、相关实验室检查、Wells评分等进行比较和统计学分析.结果最终入选患者502例,PE组246例,Non-PE组256例,近期术后或卧床、近期骨盆或下肢骨折、咯血、一过性意识障碍、单侧下肢肿胀、低氧低碳酸血症、D-dimer升高、高危Wells评分等在PE组出现的频率显著高于Non-PE组,P＜0.05,其他参数在两组中差异无统计学意义.Wells评分、D-dimer值及二者联合的ROC曲线下面积分别是0.775 (95％CI:0.719～0.831),0.802(95％CI:0.751～0.853),0.899 (95％ CI:0.834～0.964),二者联合ROC曲线下面积大于二者单独应用,P ＜0.05.截点值Wells评分5分,D-dimer 1 724.00 μg/L为敏感度与特异度加权最大值,超过截点值时,诊断PE的可靠性明显提高;低于截点值时,排除PE的可靠性也明显升高.结论 Wells评分联合D-Dimer检查比单独应用在急性肺栓塞预测中更具备临床价值.
목적 평개Wells평분연합D-dimer재급성폐전새진단적림상예측개치.방법 수집2008년지2011년취진북경조양의원급진과의사폐전새환자540례,이CTPA검사양성위학진폐전새적의거,분위폐전새(PE)조여비폐전새(Non-PE)조,대량조환자재인구학특정、기출질병、주소、체정、정맥혈전위험인소、상관실험실검사、Wells평분등진행비교화통계학분석.결과 최종입선환자502례,PE조246례,Non-PE조256례,근기술후혹와상、근기골분혹하지골절、각혈、일과성의식장애、단측하지종창、저양저탄산혈증、D-dimer승고、고위Wells평분등재PE조출현적빈솔현저고우Non-PE조,P＜0.05,기타삼수재량조중차이무통계학의의.Wells평분、D-dimer치급이자연합적ROC곡선하면적분별시0.775 (95％CI:0.719～0.831),0.802(95％CI:0.751～0.853),0.899 (95％ CI:0.834～0.964),이자연합ROC곡선하면적대우이자단독응용,P ＜0.05.절점치Wells평분5분,D-dimer 1 724.00 μg/L위민감도여특이도가권최대치,초과절점치시,진단PE적가고성명현제고;저우절점치시,배제PE적가고성야명현승고.결론 Wells평분연합D-Dimer검사비단독응용재급성폐전새예측중경구비림상개치.
Objective To evaluate the predictive value of Wells score combined with D-dimer in the diagnosis of acute pulmonary embolism.Methods A total of 540 patients with suspected pulmonary embolism admitted from 2008 to 2011 were enrolled for study.The diagnosis of pulmonary embolism (PE) was confirmed by using computed tomography pulmonary angiography (CTPA).These patients were divided into two groups:PE group and non-PE group.Comparative analysis was carried out in demographics,underlying diseases,chief complaints,physical signs,venous thrombosis risk factors,laboratory findings and Wells scores between the two groups.Results Of 502 patients selected into this study,there were 246 in PE group and 256 in Non-PE group.The incidence rates of history of recent surgery or bed-ridden,recent fracture of pelvis or lower limb,symptoms of hemoptysis,transient disturbance of consciousness,signs of unilateral lower limb swelling,hypoxia and hypocapnia of arterial blood gas analysis,elevated levels of D dimer,high Wells score in PE group were significantly higher than those in non-PE group (P ＜ 0.05).And there were no statistical difference in other variables found between the two groups.The areas under the ROC curve of Wells score,D-dimer and the combination of the two were 0.775 (95％ CI:0.719-0.831),0.802 (95 ％ CI:0.751-0.853) and 0.899 (95 ％ CI:0.834-0.964),respectively.And the area under the ROC curve of the combination of the two was greater than that of separated application (P ＜ 0.05).When the cut-off value of Wells score was 5 and D-dimer was 1 724 μg/L,the weighted maximum sensitivity and specificity were reached,and these cut-off values were higher than above determined values,the reliability of the diagnosis of PE was obviously increased,and those were lower than these cut-off values,the reliability of excluding PE was also increased.Conclusions Wells score combined with D-dimer showed a higher value in predicting acute pulmonary embolismthan than their separated application.