Wells评分、修正Geneva评分联合D-二聚体对慢阻肺急性加重合并肺栓塞风险的预测价值  

Predictive value of Wells Score,Revised Geneva Score combined with D-dimer for Pulmonary Embolism in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：程哲[1] 杨梦 张桢 代灵灵[1] 王茜[1] 贾留群[1] 景晓刚[1] 蒋天赐 安琳[1] 刘梦[1] 杨远舰 李婉芳 李妍[1] 孙迪 Cheng Zhe;Yang Meng;Zhang Zhen;Dai Lingling;Wang Xi;Jia Liuqun;ring Xiaogang;Jiang Tianci;An Lin;Liu Meng;Yang Yuanjian;Li Wanfang;Li Yan;Sun Di(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Zhengzho University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院呼吸与危重症医学科河南省高等学校临床医学重点学科开放实验室,450052 [2]郑州大学第二附属医院呼吸与危重症医学科

出　　处：《中华医学杂志》2018年第48期3925-3929,共5页National Medical Journal of China

基　　金：国家重点研发计划(2016YFC1304000);河南省科技研发专项(162102410010);河南省高等学校重点科研项目(18A320056).

摘　　要：目的评估Wells评分、修正Geneva评分联合D-二聚体对慢性阻塞性肺疾病(简称慢阻肺)急性加重(AECOPD)合并肺栓塞风险的预测价值。方法研究对象为郑州大学第一附属医院2013年3月1日至2015年12月31日因AECOPD入院且均行CT肺动脉造影的234例患者。收集患者的临床资料,根据CT肺动脉造影结果分为AECOPD合并肺栓塞组和单纯AECOPD组。对所有患者行Wells评分评分和修正Geneva评分,制作受试者工作特征(ROC)曲线,应用Z检验对ROC曲线下面积(AUC)进行比较,评价其预测价值。结果234例AECOPD患者中合并肺栓塞组32例(13.7%),单纯AECOPD组202例(86.3%)。Wells评分、修正Geneva评分、D-二聚体、Wells评分+D-二聚体、修正Geneva评分+D-二聚体的AUC分别为0.869(95%CI:0.789~0.949)、0.710(95%CI:0.588~0.832)、0.866(95%CI:0.790~0.941)、0.926(95%CI:0.874~0.977)、0.855(95%CI:0.751~0.959)。Wells评分、D-二聚体的AUC均显著大于修正Geneva评分(Z=2.14、2.12,均P<0.05);Wells评分+D-二聚体的AUC显著大于修正Geneva评分+D-二聚体(Z=2.73,P<0.05)。结论Wells评分+D-二聚体对AECOPD合并肺栓塞的预测价值比修正Geneva评分+D-二聚体高。Objective To evaluate the predictive value of Wells score,revised Geneva score combined with D-dimer for the risk of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods In this study,234 AECOPD patients underwent CT pulmonary angiography from March 1,2013 to December 31,2015 in the First Affiliated Hospital of Zhengzhou University.The basic data of the patients were collected and the patients were classified into AECOPD combined with pulmonary embolism group (pulmonary embolism group)and AECOPD group according to CT pulmonary angiography results.All patients were scored by Wells score and revised Geneva score.The receiver operating characteristic (ROC)curves were generated and the Z test was applied to evaluate the predictive value by comparing the area under the ROC curves (AUC).Results Totally 32(13.7%)patients had pulmonary embolism out of the 234 AECOPD patients.The AUC by Wells score, revised Geneva score,D-dimer,Wells score +D-dimer,revised Geneva score +D-dimer were 0.869 (95%CI:0.789-0.949),0.710(95%CI:0.588-0.832),0.866(95%CI:0.790-0.941), 0.926(95%CI:O.874-0.977),0.855(95%CI:0.751-0.959).The AUC of Wells score and D-dimer were significantly greater than that of revised Geneva score (Z =2.14,2.12,both P <0.05);the AUC of Wells seore +D-dimer was significantly greater than revised Geneva score +D-dimer (Z =2.73, P <0.05).Conelusion The predietive value of Wells score +D-dimer for pulmonary embolism in AECOPD patients is higher than revised Geneva score +D-dimer.

关 键 词：肺疾病 慢性阻塞性 肺栓塞 WELLS评分 修正Geneva评分 D-二聚体 

分 类 号：R563.5[医药卫生—呼吸系统] R563.9[医药卫生—内科学]