Wells量表和修正的Geneva评分对肺栓塞的预测价值分析
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摘要
目的:分析Wells量表和修正的Geneva评分对肺栓塞(PE)的预测价值。方法:选取2016年1月-2017年9月本院住院疑似肺栓塞患者240例,均采用Wells量表和修正的Geneva评分,经CT肺动脉血管造影(CTPA)确诊为肺栓塞者64例,建立受试者工作曲线(ROC)评价其对肺栓塞的预测价值。结果:Wells评分低度、中度、高度患者对PE预测符合率分别为3.70%(2/54)、22.88%(27/118)、51.47%(35/68);修正的Geneva评分低度、中度、高度患者符合率分别为3.95%(3/76)、22.61%(26/115)、71.43%(35/49)。修正的Geneva评分高度符合率高于Wells评分(χ~2=4.720,P=0.003),但两种评估量表低度、中度符合率比较,差异均无统计学意义(P>0.05)。Wells评分AUC为0.581,准确性较低,敏感度、特异度分别为0.626、0.718,预测截断值为3.52分;修正的Geneva评分AUC为0.702,准确性高于Wells评分,敏感度、特异度分别为0.753、0.732,预测截断值为7.58分。结论:Wells量表和修正的Geneva评分均对PE有一定的预测价值,修正的Geneva评分预测价值略高于Wells量表,临床上可以将两种评分方法结合使用,提高PE的早期诊断水平。
Objective:To analyze the predictive value of Wells scale and revised Geneva score for pulmonary embolism(PE).Method:There were 240 cases of suspected pulmonary embolism hospitalized in our hospital from January 2016 to September 2017 were selected.They were given Wells scale and revised Geneva score,and 64 cases of pulmonary embolism were confirmed by CT pulmonary angiography(CTPA).The receiver operating curve(ROC) was established to evaluate its predictive value for pulmonary embolism.Result:The low,moderate and high predictive coincidence rates of PE in Wells scale were 3.70%(2/54),22.88%(27/118) and 51.47%(35/68) respectively.The low,moderate and high predictive coincidence rates of PE in revised Geneva score were 3.95%(3/76),22.61%(26/115),71.43%(35/49) respectively.The high coincidence rate in revised Geneva score was higher than that of Wells scale( χ~2=4.720,P=0.003),but the low and moderate coincidence rates of the two assessment scales were compared,the differences were not statistically significant(P>0.05).The AUC of Wells scale was 0.581,the accuracy was low,the sensitivity and specificity were 0.626 and 0.718 respectively,and the predictive cut-off value was 3.52 point.The AUC of revised Geneva score was 0.702,higher than the Wells score,the sensitivity and specificity were 0.753 and 0.732 respectively,and the predictive cut-off value was 7.58 point.Conclusion:Wells scale and revised Geneva score have some predictive value for PE,the predictive value of revised Geneva score is slightly higher than that of Wells scale,and the combination of the two scoring methods could improve the early diagnosis of PE.
Objective:To analyze the predictive value of Wells scale and revised Geneva score for pulmonary embolism(PE).Method:There were 240 cases of suspected pulmonary embolism hospitalized in our hospital from January 2016 to September 2017 were selected.They were given Wells scale and revised Geneva score,and 64 cases of pulmonary embolism were confirmed by CT pulmonary angiography(CTPA).The receiver operating curve(ROC) was established to evaluate its predictive value for pulmonary embolism.Result:The low,moderate and high predictive coincidence rates of PE in Wells scale were 3.70%(2/54),22.88%(27/118) and 51.47%(35/68) respectively.The low,moderate and high predictive coincidence rates of PE in revised Geneva score were 3.95%(3/76),22.61%(26/115),71.43%(35/49) respectively.The high coincidence rate in revised Geneva score was higher than that of Wells scale( χ~2=4.720,P=0.003),but the low and moderate coincidence rates of the two assessment scales were compared,the differences were not statistically significant(P>0.05).The AUC of Wells scale was 0.581,the accuracy was low,the sensitivity and specificity were 0.626 and 0.718 respectively,and the predictive cut-off value was 3.52 point.The AUC of revised Geneva score was 0.702,higher than the Wells score,the sensitivity and specificity were 0.753 and 0.732 respectively,and the predictive cut-off value was 7.58 point.Conclusion:Wells scale and revised Geneva score have some predictive value for PE,the predictive value of revised Geneva score is slightly higher than that of Wells scale,and the combination of the two scoring methods could improve the early diagnosis of PE.
引文
[1]陈央,周海霞,胡月红,等.老年和非老年肺栓塞的危险因素及Caprini血栓风险评估量表的预测价值[J].中华医学杂志,2017,97(10):755-760.
[2]朱蕻潮,魏宁,徐浩,等.DSA成像血管测量参数在预测肺栓塞患者肺动脉高压中的应用价值[J].中华解剖与临床杂志,2015,20(6):523-527.
[3]牛鹿原,张欢,张福先.急性下肢深静脉血栓发生症状性肺栓塞的预测[J].中华普通外科杂志,2017,32(5):415-417.
[4]赵玉珂,冯广华.Wells评分与修正的Geneva评分对肺栓塞的预测价值研究[J].实用心脑肺血管病杂志,2014,22(10):19-22.
[5]刘运秋,杨晓燕,王丽晔,等.血清高敏C反应蛋白水平对肺栓塞预测价值的研究[J].中国循环杂志,2015,30(9):854-858.
[6]杨琼芳,季巧英,赵兰艳,等.预测CT肺动脉造影联合肺通气灌注显像检查降低肺栓塞复发率的临床价值[J].实用医学杂志,2017,33(10):1647-1650.
[7]董樑,张静,夏敬文.简化肺栓塞严重指数及联合检测pro BNP对急性肺栓塞预后的预测价值[J/OL].中华肺部疾病杂志(电子版),2017,10(3):352-354.
[8]王静,赵卉.修正的Geneva评分、心电图评分联合D-二聚体对肺栓塞的预测价值研究[J].安徽医科大学学报,2017,52(4):554-558.
[9]郭春月,胡泊,尹素凤,等.血糖水平对肺栓塞患者预后的预测价值研究[J].中国全科医学,2017,20(5):549-553.
[10]Penaloza A,Melot C,Motte S.Comparison of the Wells score with the simplified revised Geneva score for assessing pretest probability of pulmonary embolism[J].Thromb Res,2011,127(2):81-84.
[11]Douma R A,Erkens P M,Nizet T A,et al.Performance of4 clinical decision rules in the diagnostic management of acute pulmonary embolism:a prospective cohort study[J].Ann Intern Med,2011,154(11):709-718.
[12]郭晓娟,刘敏,郭佑民,等.三种临床评分方法对急性肺栓塞预测价值的比较[J].中华结核和呼吸杂志,2009,32(2):199-122.
[13]陈晓娟,梅晓冬.联合检测D-D和FIB对慢阻肺患者肺栓塞风险的预测作用[J].临床肺科杂志,2016,21(4):646-648.
[14]田园,艾芬.急诊床边超声对修正的Geneva评分中度患者肺栓塞的预测价值[J].中国实验诊断学,2012,16(5):833-835.
[15]周海霞,唐永江,王岚,等.肺栓塞远期死亡危险因素及Charlson合并症指数的预测价值[J].中华医学杂志,2016,96(4):273-276.
[16]朱亚,葛学娣,黄林娟,等.个案追踪法在骨科深静脉血栓高危患者术后管理中的应用[J].解放军护理杂志,2015,32(11):37-40.
[17]张皓,刘君,邓泽彦.骨科大手术患者静脉血栓栓塞症的早期预测[J].现代仪器与医疗,2017,23(4):24-25,54.
[18]董樑,张静,夏敬文.CHA2DS2-VASc评分量表对内科患者急性肺栓塞诊断的预测价值[J].复旦学报(医学版),2016,43(4):462-466.
[19]谭慧.颅脑外伤术后昏迷患者下肢深静脉血栓的防治及护理[J].血栓与止血学,2016,22(5):582-584,587.
[20]李保军,许志强.Wells评分联合D-二聚体诊断急性肺栓塞27例分析[J].内科急危重症杂志,2014,20(3):184-185.
[2]朱蕻潮,魏宁,徐浩,等.DSA成像血管测量参数在预测肺栓塞患者肺动脉高压中的应用价值[J].中华解剖与临床杂志,2015,20(6):523-527.
[3]牛鹿原,张欢,张福先.急性下肢深静脉血栓发生症状性肺栓塞的预测[J].中华普通外科杂志,2017,32(5):415-417.
[4]赵玉珂,冯广华.Wells评分与修正的Geneva评分对肺栓塞的预测价值研究[J].实用心脑肺血管病杂志,2014,22(10):19-22.
[5]刘运秋,杨晓燕,王丽晔,等.血清高敏C反应蛋白水平对肺栓塞预测价值的研究[J].中国循环杂志,2015,30(9):854-858.
[6]杨琼芳,季巧英,赵兰艳,等.预测CT肺动脉造影联合肺通气灌注显像检查降低肺栓塞复发率的临床价值[J].实用医学杂志,2017,33(10):1647-1650.
[7]董樑,张静,夏敬文.简化肺栓塞严重指数及联合检测pro BNP对急性肺栓塞预后的预测价值[J/OL].中华肺部疾病杂志(电子版),2017,10(3):352-354.
[8]王静,赵卉.修正的Geneva评分、心电图评分联合D-二聚体对肺栓塞的预测价值研究[J].安徽医科大学学报,2017,52(4):554-558.
[9]郭春月,胡泊,尹素凤,等.血糖水平对肺栓塞患者预后的预测价值研究[J].中国全科医学,2017,20(5):549-553.
[10]Penaloza A,Melot C,Motte S.Comparison of the Wells score with the simplified revised Geneva score for assessing pretest probability of pulmonary embolism[J].Thromb Res,2011,127(2):81-84.
[11]Douma R A,Erkens P M,Nizet T A,et al.Performance of4 clinical decision rules in the diagnostic management of acute pulmonary embolism:a prospective cohort study[J].Ann Intern Med,2011,154(11):709-718.
[12]郭晓娟,刘敏,郭佑民,等.三种临床评分方法对急性肺栓塞预测价值的比较[J].中华结核和呼吸杂志,2009,32(2):199-122.
[13]陈晓娟,梅晓冬.联合检测D-D和FIB对慢阻肺患者肺栓塞风险的预测作用[J].临床肺科杂志,2016,21(4):646-648.
[14]田园,艾芬.急诊床边超声对修正的Geneva评分中度患者肺栓塞的预测价值[J].中国实验诊断学,2012,16(5):833-835.
[15]周海霞,唐永江,王岚,等.肺栓塞远期死亡危险因素及Charlson合并症指数的预测价值[J].中华医学杂志,2016,96(4):273-276.
[16]朱亚,葛学娣,黄林娟,等.个案追踪法在骨科深静脉血栓高危患者术后管理中的应用[J].解放军护理杂志,2015,32(11):37-40.
[17]张皓,刘君,邓泽彦.骨科大手术患者静脉血栓栓塞症的早期预测[J].现代仪器与医疗,2017,23(4):24-25,54.
[18]董樑,张静,夏敬文.CHA2DS2-VASc评分量表对内科患者急性肺栓塞诊断的预测价值[J].复旦学报(医学版),2016,43(4):462-466.
[19]谭慧.颅脑外伤术后昏迷患者下肢深静脉血栓的防治及护理[J].血栓与止血学,2016,22(5):582-584,587.
[20]李保军,许志强.Wells评分联合D-二聚体诊断急性肺栓塞27例分析[J].内科急危重症杂志,2014,20(3):184-185.