Wells量表结合D-二聚体对急性肺栓塞的诊断价值  

Diagnostic value of Wells score combined with rapid plasma D-dimer assay for acute pulmonary embolism

作　　者：陈杰文[1] 林慧芯[1] 李抒玮[1] 

机构地区：[1]广东省江门市中心医院急诊科,广东江门529070

出　　处：《中国现代医生》2013年第20期156-157,160,共3页China Modern Doctor

摘　　要：目的探讨采用Wells量表结合血浆D-二聚体检测对急性肺栓塞的诊断价值。方法回顾性分析我院疑似APE患者189例,分别以Wells量表、D-二聚体检测及两者结合对急性肺栓塞做出诊断,分析各组APE诊断率。结果进行CTPA检查后诊断APE 74例。D-二聚体、Wells量表、二者结合诊断APE灵敏度分别为91.9%、89.2%、97.3%,三组比较差异有统计学意义(P<0.05)。三组诊断APE的阴性预测值分别为91.6%、90.0%、95.4%,三组比较差异有统计学意义(P<0.05)。二者结合阳性似然比2.11,阴性似然比0.05。结论 D-二聚体结合Wells量表操作简单,对APE早期筛选具有价值,能更准确地预测APE的发病风险,当二者均为阴性时,排除疑似APE更加安全有效。Objective To study the value of Wells score assessment combined with simplified rapid plasma D-dimer assay for acute pulmonary embolism （APE）. Methods Clinical data of 189 suspected cases of acute pulmonary em- bolism were retrospectively analyzed. Clinical diagnosis for APE of the patients were made based on their probability Wells score, plasma D-dimer and a combination of Wells score. Analyze APE diagnosis rate of each group. Results The results showed 74 cases were diagnosed as APE by the CTPA. Sensitivity of D-dimer, Wells score and Wells score combinative with D-direct to diagnose APE was 91.9%, 89.2% and 97.3%, which had significant difference a mong the three groups （P 〈 0.05）. Negative predictive value of three groups to diagnose APE were 91.6%, 90.% and 95.4%, which had significant difference among the three groups （P 〈 0.05）. Likelihood ratio for both positive test re- sults of 2.11 and a likelihood ratio for both negative test results of 0.05. Conclusion As a routine diagnosis test, D- dimer combined with Wells score assessment play a screening role in early diagnosis for APE, D-dimer testing com- bined with Wells score can more accurately predict the risk of APE, the rate of rulling out suspected APE is more safe and effective when they are negative.

关 键 词：急性肺栓塞 Wells量表 血浆D-二聚体 

分 类 号：R563.5[医药卫生—呼吸系统]