Wells评分联合D-二聚体对疑似急性肺栓塞患者的诊断价值

目的探索Wells评分联合D-dimer预测肺栓塞(pulmonary embolism,PE)的可靠性。方法收集2013—2016年中国科学院大学宁波华美医院疑似PE患者200例,依据肺动脉CT血管造影技术(CTPA)分为PE组和Non-PE组,对2组患者的肺栓塞相关风险因素进行统计分析;对不同的预测模型行ROC曲线分析。结果纳入183例患者,PE组101例,Non-PE组82例,慢性心功能不全、血管性病变、有DVT或PE史、呼吸困难、单侧下肢痛、下肢深静脉触痛和单肢肿胀、D-dimer升高、高危Wells评分等在2组间差异有统计学意义(均P<0.05),而其他参数差异无统计学意义(均P>0.05)。不同预测方法的ROC曲线下面积(AUC)分别是0.834(95%CI:0.758～0.911)、0.775(95%CI:0.688～0.862)、0.732(95%CI:0.643～0.820)、0.857(95%CI:0.783～0.931)、0.887(95%CI:0.820～0.954),Wells评分原始版结合D-dimer联合诊断的AUC大于简化版结合D-dimer的联合应用和三者单独应用,差异有统计学意义(均P<0.05)。当Wells评分原始版结合D-dimer联合诊断的截点值为0.96,敏感性和特异性分别为87.76%和85.37%,诊断和排除PE的可靠性最佳。结论 Wells评分原始版联合D-dimer预测PE更具有参考价值。

Value of Wells score combined with D-dimer test for the diagnosis of uncertain acute pulmonary embolism

Objective To evaluate the predictive value of different Wells score combined with D-dimer level in the diagnosis of acute pulmonary embolism (PE). Methods A total of 200 patients with suspected PE admitted in our hospital from 2013 to 2016 were enrolled into this study and divided into PE group and non-PE group by using computed tomography pulmonary angiography (CTPA). The risk factors for pulmonary embolism was investigate through statistical analysis. Receiver operating characteristic (ROC) curve analysis was used to compare the different predictive models. Results Of 183 patients included in this study, 101 patients were assigned into PE group and 82 in Non-PE group. The difference in the incident of chronic cardiac insufficiency, vascular diseases, the history of PE or DVT (deep vein thrombosis), difficult breathing, unilateral lower limb pain, lower extremity deep venous tenderness and single limb swelling, elevated levels of D-dimer, high Wells score was statistically significant between PE group and Non-PE group (all P<0.05), and not significant for other variables (all P>0.05). The areas under the ROC curves (AUC) of different assessment Methods were 0.834 (95% CI: 0.758-0.911), 0.775 (95% CI: 0.688-0.862), 0.732 (95% CI: 0.643-0.820), 0.857 (95% CI: 0.783-0.931), and 0.887 (95% CI: 0.820-0.954), respectively. The AUC for the combination of original Wells score version and D-dimer level was greater than that for the combination of simplify Wells score version and D-dimer level, and that for the method alone (all P<0.05). When the cut-off value of the combination of original Wells score version and D-dimer level was 0.96, and the weighted maximum sensitivity was 87.76% and specificity was 85.37%, and it reached the best reliability of diagnosing and eliminating PE. Conclusion Original Wells score version combined with D-dimer level shows a higher value in predicting acute pulmonary embolism than each method alone.