改良Geneva量表及其联合血浆D−二聚体对老年肺栓塞诊断价值的探讨

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。     

3种量表在心内科病房肺血栓栓塞症诊断的临床预测价值

目的:探讨目前临床较公认的3种临床评估量表在心内科肺血栓栓塞症(PTE)患者人群中的预测价值。方法:回顾性地收集以各种主诉收入我院心内科病房,并在住院期间经螺旋CT肺动脉造影(CTPA)明确诊断PTE的患者40例,对急性肺栓塞的各危险因素和临床特点进行分析,采用Wells量表、Geneva量表和修正的Geneva量表进行临床PTE的可能性评估。结果:Wells量表显示PTE中、高度可能性患者占77.5%,低度可能性者占22.5%;而修正的Geneva量表结果中、低可能性患者约各占50%,高度可能性者为0;Geneva量表结果介于中间。除量表中指标外,25%患者合并有心肺疾病,有晕厥者9例(22.5%),D-二聚体升高(70%)、心电图SⅠQⅢTⅢ(50%)、右束支传导阻滞(35%)等阳性率亦较高。结论:由于PTE临床表现的非特异性与心血管疾病的相似性,对于以不明原因呼吸困难和/或胸痛收入心内科病房的患者,应警惕PTE可能。3种临床评估量表可以作为临床PTE的基本筛查方法,对有中、高度可能性的患者应进一步行CTPA或有创检查明确;对低度可能性者不能轻易排除PTE,建议进一步行相关化验检查,评估行CTPA或有创检查确诊PTE的必要性。对不具备CTPA等检查的基层医院,3种量表在PTE诊断中的临床预测价值可能更大。     

Wells评分与修正的Geneva评分对肺栓塞的预测价值研究

目的评价Wells评分与修正的Geneva评分对肺栓塞的预测价值。方法连续选择2009年12月—2012年12月在我院住院的疑诊肺栓塞患者153例,均进行Wells评分与修正的Geneva评分,以肺动脉造影(CTPA)检查结果作为诊断肺栓塞的"金标准"。结果经CTPA检查确诊肺栓塞78例,Wells评分预测低度、中度、高度可能肺栓塞的符合率分别为0、49.5%、82.1%,修正的Geneva评分预测低度、中度、高度可能肺栓塞的符合率分别为33.3%、55.3%、90.9%。绘制ROC曲线发现,Wells评分预测肺栓塞的曲线下面积(AUC)为0.770〔95%CI(0.696,0.844)〕,修正的Geneva评分为0.733〔95%CI(0.653,0.813)〕,差异无统计学意义(P0.05)。Wells评分预测肺栓塞的最佳临界值为3.5分,此时的灵敏度为76.9%,特异度为66.7%;修正的Geneva评分预测肺栓塞的最佳临界值为5.5分,此时的灵敏度为60.3%,特异度为82.7%。结论 Wells评分与修正的Geneva评分均对肺栓塞有良好的预测价值,可根据患者情况选用或联合应用。     

三种急性肺栓塞评分预测价值比较分析

目的 回顾性分析Wells评分、Geneva评分和修改后Geneva评分对急性肺栓塞的临床可能性预测价值.方法 选择2004年1月至2006年6月宁夏医学院附属医院和2005年9月至2006年10月北京朝阳医院的可疑急性肺栓塞行CT肺血管造影(CTPA)检查的患者,分别采用Wells评分、Geneva评分和修改后Geneva评分对肺栓塞疑似患者患肺栓塞的风险度进行分级,将患者分为低度可能、中度可能和高度可能3组.以CTPA结果为标准,分析各组患者的肺栓塞确诊率.结果 共688例肺栓塞疑似患者入选本研究,CTPA诊断急性肺栓塞198例.所有患者均行Wells评分和修改后Geneva评分,490例行Geneva评分.低、中、高度可能组的肺栓塞确诊率为:Wells评分14.2%、53.9%、75.9%;Geneva评分17.2%、40.0%、47.1%;修改后Geneva评分17.1%、36.4%、62.9%.研究结果显示,随着预测风险的增加,各组患者的肺栓塞确诊率升高.Wells评分的ROC曲线下面积最大(0.8195),与Geneva评分(0.6869)和修改后Geneva评分(0.6895)相比,差异有统计学意义.Geneva评分和修改后Geneva评分的ROC曲线下面积差异无统计学意义.结论 在对住院患者的肺栓塞临床可能性预测方面,与Geneva评分和修改后Geneva评分相比,Wells评分的价值最高.     

简化Wells评分、修订版Geneva评分和4PEPS评分对肺栓塞的诊断价值

目的 探讨传统临床评分模型(简化Wells评分、修订版Geneva评分)及其联合D-二聚体对肺栓塞(PE)的诊断价值，并与新提出的4PEPS评分相对比。方法 回顾分析2020年5月至2022年5月山西省人民医院收治的疑似PE患者219人，以CT肺血管造影(CTPA)结果为金标准，将患者分为PE组和非PE组，并利用临床评分模型进行评分，分析简化Wells评分、修订版Geneva评分及其联合D-二聚体、4PEPS评分预测PE的效果。结果 219例患者中CTPA确诊为PE的79例，简化Wells评分、修订版Geneva评分及其联合D-二聚体、4PEPS诊断PE的敏感度分别为62.0%、55.7%、55.7%、49.4%、68.4%;特异度分别为78.6%、71.4%、85.0%、80.7%、68.6%;准确度分别为72.6%、65.8%、74.4%、69.4%、68.5%;Youden指数分别为0.41、0.27、0.41、0.30、0.37;Kappa值分别为0.406、0.268、0.423、0.312、0.312;AUC分别为0.735、0.688、0.790、0.743、0.683。...     

三种临床评分方法对急性肺栓塞预测价值的比较

目的 以CT肺血管造影(CTPA)为金标准,评价临床普遍应用的三种国外急性肺栓塞评分方法 的预测效能,探讨适用于我国人群的评分方法.方法 连续纳入570例(男321例,女249例,年龄18～75岁,平均55岁)行CTPA检查的临床疑似急性肺栓塞的住院或门诊患者.分别采用Wells、Geneva和改良Geneva评分法评价每例患者,并预测其急件肺栓塞发生的可能性.先由2名中年资影像学医师分别独立盲法评价CTPA,评价结果 不一致时由1名高年资医师决定.应用受试者工作特征曲线分析评价二种评分方法 的预测价值.结果 570例中169例患者确诊为急性肺栓塞.三种临床评分方法 两两一致性榆验结果 显示K值为0.269～0.374,P<0.05;其中Geneva评分和改良Geneva评分的一致度较好.三种评分方法 两两存在正相关关系,Geneva评分和改良Geneva评分之间的相关关系较密切.Wells评分、Geneva评分和改良Geneva评分对评估APE的评估的阳性预测值分别为83.8%、53.3%和61.3%,阴性预测值分别为85.0%、80.6%和80.0%.三者的受试者工作特征曲线下面积分别为:Wells评分0.823,Geneva评分0.677,改良Geneva评分0.661,三者比较,除了Geneva评分和改良Geneva评分相比差异无统计学意义(u=0.352,P>0.05)外,其余两两之间的差异均有统计学意义(u=3.535,4.285,均P<0.01).结论 三种临床评分方法 均可以对急性肺栓塞作出较为准确的预测,但是Wells评分的预测价值最高,比较适合于我国人群.     

修正的Geneva评分对肺栓塞相关的慢性阻塞性肺疾病的临床预测价值

目的 了解肺栓塞相关的慢性阻塞性肺疾病(PE-COPD)的患病率和发病特点,重点探讨Gevena评分预测PE COPD的临床价值.方法 回顾性地分析天津医科大学总医院2009年2月至2011年12月诊治的急性肺栓塞患者的临床资料,并对每例PE-COPD患者进行Geneva评分,应用受试者工作特征(ROC)曲线评价Geneva评分对PE-COPD的预测价值,同时分析该评分与肺功能、血气指标的相关性.结果 127例急性肺栓塞患者中,基础疾病为COPD的患者1 6例,患病率为12.6％(95％ CI 6.8％～18.4％);Geneva评分用于预测PE COPD的ROC曲线下面积(AUC)为0.759(P＜0.05),95％ CI为0.654～0.873,最佳临界值为5.5,≥5.5灵敏度和特异度分别为81.3％和63.1％,且患者的FEV1 ％pred、PaO2与Geneva分数呈负相关(P＜0.05),FEV1/FVC％、pH、PaCO2与Geneva分数无相关性(P＞0.05).结论 Geneva评分对PE COPD有一定的预测价值,尤其是肺功能较差、严重低氧血症的COPD患者,有较高发生肺栓塞的临床概率.     

临床评分、D-二聚体检测对急性肺栓塞的诊断价值

目的探讨临床评分、D-二聚体对急性肺栓塞的诊断价值。方法以CT肺动脉血管造影作为诊断急性肺栓塞的＂金标准＂,应用受试者工作特征（ROC）曲线及诊断试验常见评价指标,评价Wells评分、改良Geneva评分、D-二聚体检测以及这两种临床评分方法与D-二聚体检测相结合对急性肺栓塞的诊断价值。结果共102例患者确诊为急性肺栓塞,Wells评分、改良Geneva评分高度可能的阳性预测值分别为90.2%、100%,低度可能的阴性预测值分别为84.2%、88.1%,且Wells评分、改良Geneva评分低度可能与血浆D-二聚体阴性结合可进一步提高阴性预测值,分别为95.1%和97.3%。临床评分和D-二聚体的ROC曲线下面积分别为：Wells评分为0.817,改良Geneva评分为0.850,D-二聚检测为0.773,除改良Geneva评分和D-二聚体检测ROC曲线下面积有统计学差异外（Z=2.369,P=0.018）,其余两两间均无统计学差异。结论 Wells评分、改良Geneva评分可以对急性肺栓塞作出较为准确的预测,两者之间的预测价值相似。Wells评分、改良Geneva评分结合血浆D-二聚体检测是一种安全且实用的管理肺栓塞疑似患者的诊断策略。     

血浆D-二聚体阈值对慢性阻塞性肺疾病急性加重并发肺栓塞诊断策略的影响

目的 探讨不同血浆D-二聚体（DD）阈值在慢性阻塞性肺疾病急性加重（AECOPD）并发肺栓塞（PE）诊断中的价值。方法 回顾性分析2012年1月至2019年1月因AECOPD于大连医科大学附属第一医院住院并疑诊PE的205例患者的临床资料，根据CT肺动脉造影或肺通气/灌注扫描结果分为PE组（69例）和非PE组（136例），收集患者通过受试者工作特征曲线（ROC）计算DD新阈值，并分析AECOPD患者临床可能性评估联合DD新阈值、传统阈值（550μg/L）和年龄校正阈值（年龄>50岁患者血浆DD阈值为年龄×10）预测PE的价值。结果 PE组静脉血栓栓塞症病史、合并深静脉血栓、晕厥的比例及血浆DD显著高于非PE组（P<0.05）。通过ROC曲线计算最佳DD阈值为1990μg/L,DD传统阈值、年龄校正阈值和新阈值AUC比较，差异均无统计学意义（P>0.05）。简化Wells评分预测AECOPD并发PE的AUC高于修订Geneva评分（P=0.026）。简化Wells评分联合血浆DD新阈值预测AECOPD并发PE的AUC高于联合传统阈值和年龄校正阈值以及修订Geneva评分...     

三种常用肺栓塞临床评分在西宁地区的预测价值比较分析

目的 分析比较Wells评分、修正后的Geneva评分、Pisa评分三种常用肺栓塞临床评分方法在西宁地区的临床预测价值.方法 选择青海省人民医院2008年1月1日至2010年7月31日收治的可疑急性肺栓塞行CT肺血管造影(CTPA)检查的患者,分别采用三种评分方法对其风险度进行分级,应用ROC曲线比较其对西宁地区肺栓塞的诊断价值.结果 所有患者随三种评分增加肺栓塞确诊率增大(P<0.001),三条曲线所对应AUC的差异有统计学意义(P<0.05).结论 Pisa评分对肺栓塞临床预测价值较高,其敏感性和特异性总体上优于其他评分.     

Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis

The Wells score and the revised Geneva score are two most commonly used clinical rules for excluding pulmonary embolism (PE). In this study, we aimed to assess the diagnostic accuracy of these two rules; we also compared the diagnostic accuracy between them. We searched PubMed and Web of science up to April 2015. Studies assessed Wells score and revised Geneva score for diagnosis suspected PE were included. The summary area under the curve (AUC) and the 95 % confidence interval (CI) were calculated. Eleven studies were included in this meta-analysis. For Wells score, the sensitivity ranged from 63.8 to 79.3 %, and the specificity ranged from 48.8 to 90.0 %. The overall weighted AUC was 0.778 (95 % CI 0.740–0.818; Z = 9.88, P < 0.001). For revised Geneva score, the sensitivity ranged from 55.3 to 73.6 %. The overall weighted AUC was 0.693 (95 % CI 0.653–0.736; Z = 11.96, P < 0.001). 95 % CIs of two AUCs were not overlapped, which indicated Wells score was more accurate than revised Geneva score for predicting PE in suspected patients. Meta-regression showed diagnostic accuracy of these two rules was not related with PE prevalence. Sensitivity analysis by only included prospective studies showed the results were robust. Our results showed the Wells score was more effective than the revised Geneva score in discriminate PE in suspected patients.     

Comparison of the Wells and Revised Geneva Scores for the diagnosis of pulmonary embolism: an Australian experience

Background/Aims: Clinical prediction rules form an integral component of guidelines on the diagnostic approach to pulmonary embolism (PE). The Wells Score is commonly used but is subjective, while the newer Revised Geneva Score is based entirely on objective variables. The aim of this study was to compare the diagnostic accuracy of the Wells and Revised Geneva Scores for the diagnosis of PE. Methods: Patients presenting to the emergency department with clinically suspected PE and referred for CT pulmonary angiogram or ventilation/perfusion scintigraphy were evaluated. The Wells and Revised Geneva Scores were calculated on the same cohort of patients and dichotomized into low and intermediate/high probability groups. The sensitivities and specificities were compared using McNemar's test. Overall accuracy was determined using receiver operator characteristic curve analysis. Results: A total of 98 consecutive patients was included. The overall prevalence of PE was 15.3%. The frequency of PE in the low, intermediate and high probability groups was similar for both clinical prediction rules. Compared with the Revised Geneva Score, the Wells Score showed a lower sensitivity with borderline significance (46.7% vs 80.0%, P= 0.06) and a significantly higher specificity (67.5% vs 47.0%, P= 0.002). The overall accuracy of both rules was similar (P= 0.617). Conclusion: Using the accepted guidelines in which a high pretest probability leads to further imaging and a low probability leads to a D‐dimer blood test, use of the more specific Wells Score could safely reduce the number of unnecessary scans. This would need to be confirmed with larger, prospective trials.     

The sensitivities and prognostic values of the Wells and revised Geneva scores in diagnosis of pulmonary embolism in the Japanese population

Objective

To assess the sensitivities of the Wells score (WS) and the revised Geneva score (RGS) and their prognostic values in the diagnosis of pulmonary embolism (PE) in the Japanese population.

Prediction scores do not correlate with clinically adjudicated categories of pulmonary embolism in critically ill patients

BACKGROUND:

Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU).

OBJECTIVE:

To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients.

METHODS:

In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance-corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories.

RESULTS:

Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa 0.01 [95% CI −0.0643 to 0.0941]) or Wells pretest probabilities (kappa −0.03 [95% CI −0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30).

CONCLUSIONS:

Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population.     

Differences between men and women in the clinical and laboratory findings of patients diagnosed with pulmonary embolism

Pulmonary embolism (PE) could not be diagnosed correctly in 2/3 of patients saving of that pathology, and unfortunately mortality in them could be as high as 30%. In the present study, we aimed to investigate the gender differences in clinical, electrocardiography (ECG) and laboratory findings of PE patients diagnosed with contrast-enhanced helical computerized tomography of thorax. 31 patients (18 females, 58% and 13 males, 42%) were included into the study. Symptoms, risk factors, ECG and arterial blood gases were evaluated, and then Wells, Geneva and ECG scores were obtained in each subject. Alveolo-arterial (A-a) oxygen gradient was calculated as P(A-a)O2= 150-(PCO2/0.8)-PO2. Mean pulmonary artery pressure (PAP) was measured by echocardiography. In female and male patients, Wells score (4.8 +/- 1.9 and 3.2 +/- 2.2, p= 0.017); ECG score (5.9 +/- 3.6 and 3.1 +/- 1.8, p= 0.036) and mean PAP (33.5 +/- 12.3 mmHg and 23.2 +/- 10.0 mmHg, p= 0.017) were significantly different. However, between female and male patients Geneva score (4.8 +/- 1.7 and 5.0 +/- 1.6), A-a gradient (35.2 +/- 17.3 and 42.9 +/- 12.3) and PaCO2 (33.5 +/- 15.1 and 29.8 +/- 5.4) did not differ significantly (p> 0.05). Immobilization and surgical interventions as risk factors for PE were established significantly higher in females than males (50%-30.8%, p= 0.02 and 50%-23.1%, p= 0.01). In female patients with PE, Wells and ECG scores, immobilization, surgical interventions and mean PAP are significantly higher than male patients. So, in the clinical practice, these parameters may help to diagnose acute PE especially in females.     

构建肺栓塞诊治的"立体网络"势在必行

目的 探索提高肺栓塞诊治水平的有效措施.方法分析4年间本院住院的急性肺栓塞患者142例的临床诊治情况.结果 构成比:60岁以上老年人较高(73% vs 27%,P<0.05);内科患者明显多于外科(79% vs 21%,P<0.05);以呼吸科(33%)、心内科(23%)为主.死亡率:外科明显高于内科(47% vs 13%,P<0.05);呼吸内科低于心内科(4.3% vs 25%,P<0.05).结论肺栓塞为常见病,临床表现多样,涉及科室众多,单独医疗或医技科室进行诊断常造成漏诊、误诊.提高肺栓塞的诊疗水平有赖于:(1)增强诊断意识; (2)加强研究、规范治疗;(3)构建肺栓塞防治的"立体网络".