肺通气/灌注显像对老年急性肺栓塞的诊断价值

目的 通过与CT肺动脉血管造影（CTPA）比较,探讨肺V/Q显像诊断老年急性肺栓塞的价值.方法 回顾性分析2008年至2010年44例年龄≥60岁的临床疑诊急性肺栓塞患者V/Q显像、CTPA及临床资料,其中男26例,女18例;平均年龄73.50岁.V/Q显像分别以肺栓塞诊断前瞻性研究Ⅱ（PIOPEDⅡ）诊断标准及急性肺栓塞诊断前瞻性研究（PISA-PED）诊断标准作出诊断.以出院诊断为“最终诊断”,分别计算PIOPEDⅡ诊断标准、PISA-PED诊断标准、CTPA及临床Wills评分诊断结果的灵敏度、特异性及准确性.采用x2检验及Fisher确切概率法比较不同诊断标准结果间的差异,采用Kappa分析比较PIOPEDⅡ诊断标准及PISA-PED诊断标准间的一致性.结果 PIOPEDⅡ诊断标准、PISA-PED诊断标准、CTPA及临床Wills评分诊断肺栓塞的灵敏度分别为70.00％ （14/20）、84.62％ （22/26）、65.22％（15/23）和23.08％（3/13）,除Wills评分外,余三者差异均无统计学意义（x2=0.069～1.545,均P＞O.05）;四者特异性分别为80.00％（12/15）、61.11％（11/18）、93.75％（15/16）和9/10,CTPA最高（P＜0.05）;四者准确性分别为74.29％（26/35）、75.00％ （33/44）、76.92％（30/39）和52.17％（12/23）,除Wills评分外,差异均无统计学意义（r=0.005～0.070,均P＞0.05）.V/Q显像PIOPEDⅡ诊断标准及PISA-PED诊断标准的诊断符合率为77.14％（27/35）,Kappa=0.547,P＜0.05.结论 V/Q显像和CTPA诊断老年急性肺栓塞的总体准确性相当.

Ventilation/perfusion scan in the diagnosis of acute pulmonary embolism in elderly patients

Objective To compare the diagnostic efficacy of the V/Q scan and CT pulmonary angiography （CTPA） for the detection of acute pulmonary embolism （PE） in elderly patients.Methods Fortyfour patients （age ≥60 years old） with suspected acute PE underwent V/Q scan and CTPA.The diagnosis of PE by V/Q scan was based on the criteria of prospective investigation of PE diagnosis （PIOPED） Ⅱ and the prospective investigative study of acute PE diagnosis （PISA-PED）.The final diagnosis was made clinically.The sensitivities,specificities and accuracies of PIOPED Ⅱ,PISA-PED,CTPA and Wills score were calculated and compared using x2 and Fisher＇s exact tests.Kappa analysis was used to analyze the diagnostic accordance rate of PIOPED Ⅱ and PISA-PED.Results The sensitivities of PIOPED Ⅱ,PISA-PED and CTPA in the diagnosis of PE were 70.00％ （14/20）,84.62％ （22/26） and 65.22％ （15/23）,respectively （x2 =0.069-1.545,all P＞0.05）.The sensitivity of Wills score was significantly lower （23.08％,3/13）.The specificity of CTPA （93.75％,15/16） was significantly higher than those of PIOPED lⅡ and PISAPED （80.00％,12/15 and 61.11％,11/18,both P＜0.05）.The accuracies of PIOPED Ⅱ,PISA-PED and CTPA were 74.29％ （26/35）,75.00％ （33/44） and 76.92％ （30/39）,respectively （x2 =0.005-0.070,all P＞0.05）.The accuracy of Wills score was significantly lower （52.17％,12/23）.The diagnostic accordance rate of PIOPED Ⅱ and PISA-PED criteria was 77.14％（27/35）,Kappa=0.547,P＜0.05.Conclusion V/Q scan and CTPA have no significant difference for the diagnosis of PE in the elderly patients.