Wells评分联合D-二聚体检测在诊断创伤后下肢深静脉血栓形成中的似然比分析  

Likelihood ratio test about Wells score combined with D-Dimer in the diagnosis of deep vein thrombosis in the lower extremities of trauma patients

作　　者：杨广林[1] 黄晟[1] 郑元超[1] 

机构地区：[1]上海交通大学医学院附属第三人民医院普外科,201900

出　　处：《中华临床医师杂志（电子版）》2012年第8期28-31,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的评价Wells评分联合D-二聚体检测在诊断创伤后下肢深静脉血栓形成(DVT)中的应用价值。方法回顾性分析59例确诊为创伤后DVT的临床资料以及60例无DVT的同期住院患者的临床资料,分别以Wells评分、D-二聚体以及二者联合与有无DVT的诊断结果进行似然比等分析。结果 Wells评分在诊断创伤后DVT中灵敏度为91.53%、阴性预测值为91.07%;D-二聚体检测在诊断创伤后DVT中灵敏度为93.22%、阴性预测值为92.59%,阴性似然比为0.08;Wells评分结合D-二聚体检测在诊断创伤后DVT中的特异度为91.67%、灵敏度为94.91%、阳性预测值为91.80%、阴性预测值为94.83%、阳性似然比为11.30、阴性似然比为0.06。结论 Wells评分结合D-二聚体检测可以确定创伤后DVT诊断。如果Wells评分<2而且D-二聚体检测结果为阴性就可以基本排除DVT诊断;如果Wells评分≥2而且D-二聚体检测结果为阳性就应该考虑DVT诊断。两项指标联合评估可以避免一些不必要的搬动创伤患者,减少检查,降低费用。Objective To evaluate the values of Wells score combined with D-Dimer in the diagnosis of deep vein thrombosis （DVT） in the lower extremities of trauma patients. Methods Retrospective analysis the clinical data of 59 patients with DVT and 60 patients without DVT,which from 1 January 2005 to 31 August 2010, use likelihood ratio test to evaluate the value of Wells score combined and not-combined with D-Dimer in the diagnosis of DVT in the lower extremities of trauma patients. Results The sensitivity values of Wells score and D-Dimer to diagnose DVTs were 91.53% and 93.22%, respectively. The negative predictive values of Wells score and D-Dimer to diagnose DVTs were 91.07% and 92. 59% ,respectively. As Wells score combined with D-Dimer in the diagnosis of DVT,the sensitivity value was 94. 91%, specificity 91.67% , positive predictive value 91.80% , negative predictive value 94. 83% ,positive likelihood ratio I 1.30, negative likelihood ratio 0. 06. Conclusions Wells score 〈 2 and negative D-Dimer can basically exclude the diagnosis of DVT in the lower extremities of trauma patients. Wells score ≥2 and positive D-Dimer suggests the diagnosis of DVT in the lower extremities of trauma patients. Wells score and D-Dimer may avert costly workup.

关 键 词：静脉血栓形成 嘧啶二聚物 WELLS评分 似然比 

分 类 号：R654.3[医药卫生—外科学]