心电图评分对急性肺栓塞危险程度的预测价值

目的 探讨Daniel 心电图评分在急性肺栓塞（ APE） 危险程度评估中的应用价值。方法 选择2005 年1 月至2012 年7 月于哈尔滨医科大学第一附属医院就诊并确诊的205 例APE 患者, 采集患者入院24 h 内心电图, 按照Daniel 心电图评分系统计算得分。评价心电图波形、Daniel 分值与危险分层、肺动脉收缩压（ SPAP） 、舒张末期右室前后径（ DDRV） 等相关指标的关系。应用ROC曲线评价Daniel 心电图评分预测APE 患者严重程度的准确性。结果 APE 患者中常见的心电图改变： 胸前导联出现T波倒置（ 167 例, 占81. 5% ） , 以V1 （ 165 例, 占80. 5% ） 、V2 （ 115 例, 占55. 6% ） 显著; APE 患者心电图评分中位数7 分, 与SPAP、DDRV 呈正相关（ r = 0. 482, P 〈 0. 01; r =0. 566, P 〈0. 01） , 与PaCO2 呈负相关（ r = - 0. 316, P 〈0. 01） 。与低危组比较, 中危组、高危组APE 患者Daniel分值均明显增高。在ROC 曲线分析中, Daniel 分值预测高危APE 和SPAP≥50 mm Hg（ 1 mmHg =0. 133 kPa） 的准确性ROC 曲线下面积分别为0. 667、0. 739, Daniel 分值≥5. 5 分时预测APE 危险分层的敏感性、特异性、阳性预测值、阴性预测值在高危组： 84. 6% 、44. 8% 、9. 4% 和97. 8% ; Daniel 分值≥14. 5分时预测SPAP≥50 mmHg 的敏感性、特异性为20. 7% 和91. 9% 。结论 心电图和Daniel心电图评分系统与APE 患者的严重程度有良好的相关性, 应用Daniel 心电图评分系统对APE 严重程度有较好的预测价值。

The PredictiveValue of ElectrocardiogramScoring Systemin Severity of Acute Pulmonary Embolism

Objective To study the value of the 21-Daniel electrocardiogram （ ECG） score inassessing the risk of acute pulmonary embolism （ APE） .？Methods A total of 205 patients confirmed aspulmonary embolism in the First Affiliated Hospital of HarbinMedical University were recruited in this studyfromJanuary 2005 to July 2012. 12-leads ECG was performed within the first 24 hours, and the scoresaccording to the 21-Daniel ECG scoring system were calculated. The relationships between ECG waveform,Daniel ECG scores and risk stratification, systolic pulmonary artery pressure（ SPAP） , and diastolic diameterof the right ventricle（ DDRV） were evaluated. Receiver operator characteristic （ ROC） curve was taken toassess the accuracy of ECG score in predicting the severity of APE.？Results The ECG pattern of inverted Twave in precordial leads was the most frequent ECG waveformof APE, the median of Daniel ECG score was 7points. ECG score was positively correlated with SPAP, DDRV （ r =0. 482, P 〈0. 01; r =0. 566, P 〈0. 01） ,and was negatively correlated with PaCO2 （ r= - 0. 316, P 〈0. 01） . Comparing with low-risk group, the ECGscores of intermediate-risk and high-risk groups were significantly increased. The area under the curve ofROC evaluating the accuracy of high-risk and SPAP（ ≥50 mm Hg） by ECG score were 0. 667 and 0. 739respectively. ECG score with a cutoff value of ≥5. 5 points could predict high-risk APE with a sensitivity of 84. 6% , a specificity of 44. 8% , a positive predictive value of 9. 4% and a negative predictive value of 97. 8%.With a cut-off value of ≥14. 5 points for predicting severe pulmonary hypertension （ SPAP≥50 mmHg） , ECGscoring systemdemonstrated a sensitivity of 20. 7% and a specificity of 91. 9% .？Conclusions A positive relationship is observed between the Daniel ECG score and the severity of APE. 21-ECG score is valuable forpredicting severity of APE.