疑诊下肢深静脉血栓患者临床可能性预测评分研究

目的 评价Wells评分、Kahn评分、St.André评分和Constans评分对中国疑诊下肢深静脉血栓(DVT)住院患者的诊断价值.方法 以进行下肢加压静脉超声检查作为诊断下肢DVT的金标准,274例疑诊下肢DVT的中国住院患者分别进行Wells、Kahn、St.André和Constans四种临床评分,将低可能组的患者作为下肢DVT阴性患者,中度可能和高度可能组的患者作为下肢DVT阳性患者,分别计算和比较每种临床评分诊断下肢DVT的敏感性、特异性、阳性预测值、阴性预测值和ROC曲线下面积.结果 Wells评分诊断下肢DVT的敏感性为77.3％,特异性为65.6％,阳性预测值为51.5％,阴性预测值为85.9％;Kahn评分诊断下肢DVT的敏感性为58.0％,特异性为55.9％,阳性预测值为38.3％,阴性预测值为73.8％;St.André评分诊断下肢DVT的敏感性为64.8％,特异性为55.4％,阳性预测值为40.7％,阴性预测值为76.9％.Constans评分诊断下肢DVT的敏感性为86.4％,特异性为37.6％,阳性预测值为39.6％,阴性预测值为85.4％.Wells评分(0.761)和Constans评分(0.759)的ROC曲线下面积相似,其后为St.André评分(0.627),最后Kahn评分(0.591).结论 通过比较Wells评分、Constans评分、St.André评分和Kahn评分在中国住院下肢DVT患者中的研究显示.Wells评分、Constans评分诊断准确性较高.

Predicting value of various clinical probability scores for diagnosis of lower limb deep venous thrombosis in Chinese patients

Objective To evaluate the predicting value of Wells,Kahn,St.André and Constans scores for the diagnosis of deep venous thrombosis in Chinese patients.Methods A total of 274 patients suspected with deep venous thrombosis was prospectively blinded evaluated with the four clinical-score systems.Sensitivity,specificity,positive predictive value,negative predictive value and receiver operation curves were calculated for four clinical scores according sonography results.Results Sonography evidenced deep venous thrombosis in 88 out of 274 patients.The sensitivity,specificity,positive predictive value and negative predictive value was 77.3％,65.6％,51.5％ and 85.9％,respectively,for Wells score; 58％,55.9％,38.3％ and 73.8％,respectively,for Kahn score; 64.8％,55.4％,40.7％ and 76.9％,respectively,for St.André score and 86.4％,37.6％,39.6％ and 85.4％,respectively,for Constans score.ROC was 0.761 for Wells score,which was similar as that of Constans score (0.759),then followed by St.André score (0.627) and Kahn score (0.591 ).Conclusion Our results showed that Wells score and Constans score are superior to Kahn score or St.André score for diagnosing patients with suspected deep venous thrombosis in terms of sensitivity,negative prediction value and ROC values.