Wells评分和改良Geneva评分对肺栓塞的诊断价值  

Predication of Wells and revised Geneva score for pulmonary embolism

作　　者：马育霞[1] 刘毅 王鹏升[1] 李英[1] 赵红英[1] 刘云峰[1] 李建英 李楠 

机构地区：[1]河北省沧州市中心医院老年内科,061001 [2]河北省沧州市监狱医院内科,061001

出　　处：《白求恩医学杂志》2014年第4期323-325,共3页Journal of Bethune Medical Science

基　　金：河北省沧州市科技项目基金资助课题(1213056ZD)

摘　　要：目的：为减少肺栓塞误诊漏诊，探讨并应用受试者工作特征曲线（ receiver operator characteristic curve ， ROC曲线），比较改良Geneva评分和Wells评分系统对肺栓塞的预测价值。方法选择临床疑似诊断为肺栓塞并接受经CT肺动脉造影（ CTPA）检查的患者637例，确诊肺栓塞256例，临床医师用Wells评分和改良Geneva评分对患者进行临床评分，应用ROC曲线比较两种评分法对肺栓塞的预测价值。结果 Wells评分＜2分肺栓塞可能性为7．7％，2～6分为57．3％，＞6分为83．3％；改良Geneva评分0～3分肺栓塞可能性12．1％，4～10分为46．6％，≥11分为60．0％。 Wells评分预测肺栓塞的ROC曲线下面积（AUC）0．849（95％Cl：0．817～0．881），最佳分界值2．75分；改良Geneva 评分ROC的AUC为0．813（95％Cl：0．778～0．849），最佳分界值6．5分；两条曲线所对应AUC的差异有统计学意义（ P ＜0．05）。结论 Wells评分和改良Geneva评分对肺栓塞的预测均具有较高的临床价值；Wells评分的敏感性和特异性优于改良Geneva评分。Objective To reduce misdiagnosis and underdiagnosis rates of pulmonary embolism ,the prediction of the Wells score and revised Geneva score for pulmonary embolism were compared and analyzed by receiver operating characteristic curves .Meth-ods Six hundred and thirty-seven cases with suspected pulmonary embolism （ PE） were collected ,among whom 256 cases with PE were clinically confirmed .Before CTPA test or on condition that test results were unknown ,clinical scoring was assessed prospectively by the Wells score and the Revised Geneva score .ROC curves was used to evaluate the probability of PE predicted by the Wells and the re -vised Geneva scores.Results The prevalence of PE was 7.7% with a low clinical probability （Wells Score6 points）.The confirmed PE was 12.1%with a low probability（Geneva score 0-3 points）,46.6% in intermediate probability（4-10 points）,60.0% in high probability（score≥11 points）.The area under curve （AUC） of the ROC curve in the Wells and Geneva scores was 0.849（95%Cl：0.817-0.881） and 0.813（95%Cl：0.778-0.849）.Optimal cut off value was 2.75 points in the Wells Score and 6.5 points in the Geneva score .The comparison of the area under curve between the Wells and the Geneva score had a statistically signifcant difference （ P 〈0.05）.Conclusion The Wells score and the revised Geneva score are valuable in prediction of pulmonary embolism .The Wells score is generally superior to the revised Geneva score .

关 键 词：肺栓塞 预测 WELLS评分 Geneva评分 

分 类 号：R563.5[医药卫生—呼吸系统]