临床预测评分与D-二聚体结合诊断肺动脉栓塞的价值分析  

The value analysis of clinical prediction score and D-dimer combination in the diagnosis of pulmonary embolism

作　　者：王欣[1] 贾俐聪 冯靖涛[1] 

机构地区：[1]天津市第四医院放射科,天津300222

出　　处：《吉林医学》2016年第3期601-602,621,共3页Jilin Medical Journal

摘　　要：目的:为提高肺动脉栓塞早期预测诊断能力,探讨并应用受试者工作特征曲线(ROC)分析比较D-二聚体、Wells评分和改良Geneva评分对肺栓塞的预测诊断价值。方法:回顾性分析50例疑似肺动脉栓塞患者,先后进行D-二聚体、Wells评分和改良Geneva评分及螺旋CT肺动脉造影(CTPA),应用ROC曲线比较D-二聚体、Wells评分和改良Geneva评分对肺栓塞的预测诊断价值。结果:D-二聚体诊断肺动脉栓塞的准确率为80%,明显高于Wells评分(40%)和改良Geneva评分(72%),D-二聚体检测阳性和改良Geneva评分相结合的诊断准确率为94.7%(36/38),显著高于单纯使用临床预测评分的诊断准确率;Wells评分和改良Geneva评分越高,肺栓塞的可能性越大,改良Geneva评分中各分层的预测准确度明显高于Wells评分。D-二聚体、Wells评分和改良Geneva评分ROC曲线下面积分别为(0.891±0.047)、(0.766±0.073)和(0.815±0.070),组间差异具有统计学意义(<0.05)。30例D-二聚体阴性的疑似肺动脉栓塞患者,在日后随访(3个月)的检查中均未发现肺动脉栓塞。结论:D-二聚体和改良Geneva评分相结合,是早期预测诊断肺动脉栓塞的有效手段。Objective In order to improve the early diagnosis of pulmonary embolism prediction ability,study and application of the receiver operating characteristic curve（ ROC） analysis and comparison of plasma D- dimer,Wells score and modified Geneva score predictive value in diagnosis of pulmonary embolism. Method A retrospective analysis of 50 patients with suspected pulmonary embolism patients,plasma D- dimer,Wells score and modified Geneva score and spiral CT pulmonary angiography（ CTPA） examination. Application of ROC curve comparison of plasma D- dimer,Wells score and modified Geneva score predictive value in diagnosis of pulmonary embolism. Results The accuracy rate of plasma D- dimer in the diagnosis of pulmonary embolism was 80%,which was significantly higher than the Wells score（ 40%） and modified Geneva score（ 72%）. The diagnostic accuracy rate of D- dimer detection and modified Geneva score combined was 94. 7%（ 36 /38）,which was significantly higher than only using clinical prediction score diagnosis accuracy rate; Wells score and modified Geneva score was higher,the greater the probability of pulmonary embolism,predict the layered modified Geneva score was significantly higher than that in the accuracy of Wells score,The plasma D- dimer,Wells score and modified Geneva score ROC curve prediction area pulmonary embolism respectively（ 0. 891 ± 0. 047）,（ 0. 766 ± 0. 073） and（ 0. 815 ± 0. 070）,statistically significant difference between groups（ P〈0. 05）. 30 cases of plasma D- dimer detection with suspected pulmonary embolism negative,in the later follow- up（ 3 months）imaging were not found in pulmonary embolism. Conclusion The combination of plasma D- dimer and modified Geneva score is an effective means to predict early diagnosis of pulmonary embolism

关 键 词：肺动脉栓塞 D-二聚体 WELLS评分 改良Geneva评分 螺旋CT肺动脉造影 

分 类 号：R743.33[医药卫生—神经病学与精神病学]