Wells评分和YEARS法对肺栓塞诊断价值的比较
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摘要
目的:探讨深静脉血栓可能性评分(Wells评分)和简便诊断处理可疑肺栓塞(YEARS法)对肺栓塞患者的诊断价值,应用受试者工作特征(ROC)曲线对比Wells评分和YEARS法诊断肺栓塞的曲线下面积(AUC),以期发现更适用于临床的肺栓塞评分方法。方法:选取因疑似肺栓塞的住院患者139例,其中临床确诊肺栓塞患者48例,收集所有入选患者的病史、临床表现和辅助检查等结果,所有入选研究对象均进行Wells评分和YEARS法评估,将肺动脉血管造影(CTPA)作为诊断的金标准,应用SPSS 22.0统计软件分析2组患者Wells评分和YEARS法诊断肺栓塞的灵敏度、特异度、误诊率、漏诊率和准确度,并对Wells评分、YEARS法和CTPA的结果进行一致性分析,进一步绘制Wells评分和YEARS算法诊断肺栓塞的ROC曲线,计算并比较AUC。结果:与YEARS法比较,Wells评分对肺栓塞诊断的特异度和准确度明显升高(P<0.05),误诊率明显降低(P=0.037),而灵敏度和漏诊率差异无统计学意义(P>0.05)。Wells评分与CTPA的Kappa值为0.45,一致性强度为中度;YEARS法与CTPA的Kappa值为0.22,一致性强度尚可;Wells评分与YEARS法的Kappa值为0.11,一致性较差。Wells评分方法诊断肺栓塞的AUC为0.753±0.044 (P<0.01),YEARS法诊断肺栓塞的AUC为0.585±0.049 (P=0.101)。结论:Wells评分在肺栓塞诊断评估方面总体上优于YEARS法。
Objective:To explore the diagnostic values of Wells score and YEARS algorithm in the patients with pulmonary embolism and to compare the areas under receiver operating characteristic(ROC)curves(AUC)of Wells score and YEARS algorithm,and to find the more suitable score method for pulmonary embolism in clinic.Methods:A total of 139 patients who were suspected with pulmonary embolism were collected,among them48 patients were clinically as confirmed pulmonary embolism.The disease history,clinical manifestation and results of auxilliary examinations of the patients were collected.All the patients were assessed by Wells score and YEARS algorithm,respectively;the computed tomographic pulmonary angiography(CTPA)was considered as golden standard.The sensitivities,specificities,misdiagnosis rates and omission diagnostic rates,and the accuracies of Wells score and YEARS algorithm of the patients in two groups were analyzed with SPSS 22.0 software;the conformities of results of Wells socre,YEARS algorithm,and CTPA were analyzed.Then ROC curves of Wells score and YEARS algorithm in diagnosis of pulmonary embolism were made,and the AUC was calculated and compared.Results:Compared with YEARS algorithm,the specificity and accuracy of Wells score in diagnosis of pulmonary embolism were markedly increased(P<0.05),the misdiagnosis rate was decreased(P=0.037),however the sensitivity and the misdiagnosis rate had no significant differences(P>0.05).The Kappa value of Wells score and CTPA was 0.45,the conformity was moderate;the Kappa value of YEARS algorithm and CTPA was 0.22,the conformity was passable;the Kappa value of Wells score and YEARS algorithm was 0.11,the conformity was bad.The AUC of Wells score and YEARS algorithm were 0.753±0.044(P<0.01)and 0.585±0.049(P=0.101).Conclusion:The Wells score is superior to the YEARS algorithm in the diagnosis of pulmonary embolism.
Objective:To explore the diagnostic values of Wells score and YEARS algorithm in the patients with pulmonary embolism and to compare the areas under receiver operating characteristic(ROC)curves(AUC)of Wells score and YEARS algorithm,and to find the more suitable score method for pulmonary embolism in clinic.Methods:A total of 139 patients who were suspected with pulmonary embolism were collected,among them48 patients were clinically as confirmed pulmonary embolism.The disease history,clinical manifestation and results of auxilliary examinations of the patients were collected.All the patients were assessed by Wells score and YEARS algorithm,respectively;the computed tomographic pulmonary angiography(CTPA)was considered as golden standard.The sensitivities,specificities,misdiagnosis rates and omission diagnostic rates,and the accuracies of Wells score and YEARS algorithm of the patients in two groups were analyzed with SPSS 22.0 software;the conformities of results of Wells socre,YEARS algorithm,and CTPA were analyzed.Then ROC curves of Wells score and YEARS algorithm in diagnosis of pulmonary embolism were made,and the AUC was calculated and compared.Results:Compared with YEARS algorithm,the specificity and accuracy of Wells score in diagnosis of pulmonary embolism were markedly increased(P<0.05),the misdiagnosis rate was decreased(P=0.037),however the sensitivity and the misdiagnosis rate had no significant differences(P>0.05).The Kappa value of Wells score and CTPA was 0.45,the conformity was moderate;the Kappa value of YEARS algorithm and CTPA was 0.22,the conformity was passable;the Kappa value of Wells score and YEARS algorithm was 0.11,the conformity was bad.The AUC of Wells score and YEARS algorithm were 0.753±0.044(P<0.01)and 0.585±0.049(P=0.101).Conclusion:The Wells score is superior to the YEARS algorithm in the diagnosis of pulmonary embolism.
引文
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[13]FILIPIAK-STRZECKA D,KASPRZAK J D,LIPIEC P.Brief cardiovascular imaging with pocket-size ultrasound devices improves the accuracy of the initial assessment of suspected pulmonary embolism[J].Int J Cardiovasc Imaging,2018,34(10):1595-1605.
[14]KOZLOWSKA M,PLYWACZEWSKA M,KOC M,et al.D-dimer assessment improves the simplified pulmonary embolism severity index for in-hospital risk stratification in acute pulmonary embolism[J].Clin Appl Thromb Hemost,2018,24(8):1340-1346.
[15]JAQUET E,TRITSCHLER T,STALDER O,et al.Prediction of short-term prognosis in elderly patients with acute pulmonary embolism:validation of the RIETEscore[J].J Thromb Haemost,2018,16(7):1313-1320.
[16]张佳,赵凤芹,谭平,等.凝血酶原基因G20210A突变检测对肺血栓栓塞症的预测价值[J].吉林大学学报:医学版,2014,40(5):1080-1084.
[17]王建国,朱力,刘敏,等.三种急性肺栓塞评分预测价值比较分析[J].中国实用内科学杂志,2009,29(4):322-324.
[18]REPPLINGER M D,NAGLE S K,HARRINGA J B,et al.Clinical outcomes after magnetic resonance angiography(MRA)versus computed tomographic angiography(CTA)for pulmonary embolism evaluation[J].Emerg Radiol,2018,25(5):469-477.
[19]中华医学会心血管病学分会.急性肺栓塞诊断与治疗中国专家共识[J].中华心血管病杂志,2016,44(3):197-211.
[20]RIGHINI M,ROBERT-EBADI H,LE GAL G.Diagnosis of acute pulmonary embolism[J].J Thromb Haemost,2018,38(1):11-21.
[21]STOEVA N,KIROVA G,STANEVA M,et al.Recognition of unprovoked(idiopathic)pulmonary embolismProspective observational study[J].Respir Med,2018,135:57-61.
[22]RIGHINI M,BOUNAMEAUX H.External validation and comparison of recently described prediction rules for suspected pulmonary embolism[J].Curr Opin Pulm Med,2004,10(5):345-349.
[2]ZHU R,MA X C.clinical value of ultrasonography in diagnosis of pulmonary embolism in criticallyⅢPatients[J].J Transl Int Med,2017,5(4):200-204.
[3]VAN DER HULLE T,CHEUNG W Y,KOOIJ S,et al.Simplified diagnostic management of suspected pulmonary embolism(the YEARS study):aprospective,multicentre,cohort study[J].Lancet,2017,390(10091):289-297.
[4]SHEN J H,CHEN H J,CHEN J R,et al.Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism:a systematic review and meta-analysis[J].J Thromb Thrombolysis,2016,41(3):482-492.
[5]KWON D,MILLIRON M.Update:D-dimer test for excluding the diagnosis of pulmonary embolism[J].Ann Emerg Med,2017,70(3):e31-e32.
[6]TURAN O,TURGUT D,GUNAY T,et al.The contribution of clinical assessments to the diagnostic algorithm of pulmonary embolism[J].Adv Clin Exp Med,2017,26(2):303-309.
[7]WILTS I T,L E GAL G,DEN EXTER P L,et al.Performance of the age-adjusted cut-off for D-dimer in patients with cancer and suspected pulmonary embolism[J].Thromb Res,2017,152:49-51.
[8]张英为,李立.肺栓塞88例临床分析[J].吉林大学学报:医学版,2002,28(6):644-646
[9]MA Y,WANG Y,LIU D,et al.A safe strategy to rule out pulmonary embolism:The combination of the Wells score and D-dimer test:One prospective study[J].Thromb Res,2017,156:160-162.
[10]HARRINGA J B,BRACKEN R L,NAGLE S K,et al.Negative D-dimer testing excludes pulmonary embolism in nonhigh risk patients in the emergency department[J].Emerg Radiol,2017,24(3):273-280.
[11]BUCHANAN I,TEEPLES T,CARLSON M,et al.Pulmonary embolism testing among emergency department patients who are pulmonary embolism rule-out criteria negative[J].Acad Emerg Med,2017,24(11):1369-1376.
[12]KLINE J A.Diagnosis and exclusion of pulmonary embolism[J].Thromb Res,2017,163:207-220.
[13]FILIPIAK-STRZECKA D,KASPRZAK J D,LIPIEC P.Brief cardiovascular imaging with pocket-size ultrasound devices improves the accuracy of the initial assessment of suspected pulmonary embolism[J].Int J Cardiovasc Imaging,2018,34(10):1595-1605.
[14]KOZLOWSKA M,PLYWACZEWSKA M,KOC M,et al.D-dimer assessment improves the simplified pulmonary embolism severity index for in-hospital risk stratification in acute pulmonary embolism[J].Clin Appl Thromb Hemost,2018,24(8):1340-1346.
[15]JAQUET E,TRITSCHLER T,STALDER O,et al.Prediction of short-term prognosis in elderly patients with acute pulmonary embolism:validation of the RIETEscore[J].J Thromb Haemost,2018,16(7):1313-1320.
[16]张佳,赵凤芹,谭平,等.凝血酶原基因G20210A突变检测对肺血栓栓塞症的预测价值[J].吉林大学学报:医学版,2014,40(5):1080-1084.
[17]王建国,朱力,刘敏,等.三种急性肺栓塞评分预测价值比较分析[J].中国实用内科学杂志,2009,29(4):322-324.
[18]REPPLINGER M D,NAGLE S K,HARRINGA J B,et al.Clinical outcomes after magnetic resonance angiography(MRA)versus computed tomographic angiography(CTA)for pulmonary embolism evaluation[J].Emerg Radiol,2018,25(5):469-477.
[19]中华医学会心血管病学分会.急性肺栓塞诊断与治疗中国专家共识[J].中华心血管病杂志,2016,44(3):197-211.
[20]RIGHINI M,ROBERT-EBADI H,LE GAL G.Diagnosis of acute pulmonary embolism[J].J Thromb Haemost,2018,38(1):11-21.
[21]STOEVA N,KIROVA G,STANEVA M,et al.Recognition of unprovoked(idiopathic)pulmonary embolismProspective observational study[J].Respir Med,2018,135:57-61.
[22]RIGHINI M,BOUNAMEAUX H.External validation and comparison of recently described prediction rules for suspected pulmonary embolism[J].Curr Opin Pulm Med,2004,10(5):345-349.