临床评分和D-二聚体检查在下肢深静脉血栓中的应用

目的 评价临床Wells评分和(或)D-二聚体检查能否安全、可靠地排除或诊断下肢深静脉血栓(DVT).方法 回顾性收集两家医院疑诊DVT的住院患者,所有患者均在48 h内进行临床评价、D-二聚体检查和双侧下肢静脉加压超声检查.比较单独应用临床评分或D-二聚体检查,以及临床评分结合D-二聚体检查诊断DVT的敏感性、特异性、阳性预测值和阴性预测值.描述性资料采用频数分析,组间比较采用卡方检验,以P<0.05为差异有统计学意义.结果 共有274例患者纳入研究.以低度可能性为阴性结果,中、高度可能性为阳性结果,临床Wells评分诊断DVT的敏感性、特异性、阳性预测值和阴性预测值分别为78.4%、66.1%、52.3%和86.6%;以D-二聚体≥500μg/L为阳性结果,D-二聚体检查诊断DVT的敏感性、特异性、阳性预测值和阴性预测值分别为73.9%、66.1%、50.8%和84.2%;以低度可能性同时D-二聚体<500μg/L为阴性结果,中、高度可能性同时D-二聚体≥500μg/L为阳性结果,临床Wells评分结合D-二聚体检查诊断DVT的敏感性、特异性、阳性预测值和阴性预测值分别为88.3%、76.8%、67.1%和92.5%.结论 针对临床疑诊DVT的患者,单独应用临床Wells评分或D-二聚体检查,以诊断或排除DVT是不准确的;联合应用临床Wells评分和D-二聚体检查,才能对患者是否患有DVT作出较为准确的判断.

Value of combined Wells score and D-dimer test on diagnosing patients with deep venous thrombosis

Objective To evaluate the value of Wells score or/and D-dimer test on diagnosing or excluding deep venous thrombosis (DVT). Methods Patients with suspected DVT were retrospectively analyzed. All patients underwent clinical assessment, D-dimer assay and bilateral lower extremity eompression sonography within 48 hours of admission. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing DVT by Wells score, D-direct test, and combined Wells score and D-dimer were compared. Results A total of 274 patients were analyzed. If low probability was defined as negative and moderate and high probabilities were defined as positive, the sensitivity, specificity, PPV and NPV of the Wells score were 78.4%, 66.1%, 52.3% and 86.6%, respectively. At a cut-off of 500 μg/L, the sensitivity, specificity, PPV and NPV of D-dimer test were 73.9% ,66.1%, 50.8% and 84. 2%, respectively. If low probability and D-dimer < 500 μgL were defined as negative, moderate and high probabilities and D-dimer≥500 μg/L were defined as positive, the sensitivity, specificity, PPV and NPV of the combined Wells score and D-dimer test were 88.3%, 76.8%, 67.1% and 92.5% , respectively. Conclusion For clinical suspected DVT patients, DVT diagnosis could be reliably obtained by combined Wells score and D-dimer test.