临床症状评分、血浆D-二聚体及综合超声检查对肺血栓栓塞症的诊断价值  

Diagnostic value of clinical symptom scores,plasma D-dimer and comprehensive ultrasonography for pulmonary thromboembolism

作　　者：周占文[1] 

机构地区：[1]辽宁中医药大学附属医院医学影像科,沈阳市110031

出　　处：《广西医学》2017年第12期1827-1829,共3页Guangxi Medical Journal

摘　　要：目的探讨临床症状评分、血浆D-二聚体(D-D)及综合超声对肺血栓栓塞症(PTE)的诊断价值。方法经CT肺动脉造影(CTPA)确诊PTE 142例患者设为PTE组,疑似PTE并经CTPA排除诊断的68例患者设为非PTE组。两组患者均于治疗前进行肺栓塞Wells评分、改良Geneva评分,同时行血浆D-D检测、下肢深静脉超声及心脏超声检查。比较两组患者以上指标的阳性率,并以CTPA结果为金标准,分析上述相关指标对PTE的诊断效能。结果 PTE组患者Wells评分、改良Geneva评分、血浆D-D、下肢深静脉超声、心脏超声的阳性率均明显高于非PTE组(P<0.05)。以Wells评分、改良Geneva评分、血浆D-D、下肢深静脉超声、心脏超声检查诊断PTE时,其阳性似然比均<10,阴性似然比均>0.1,但下肢深静脉超声诊断PTE的Youden指数最高(>0.6)。结论下肢超声检查发现静脉血栓时对PTE具有最大的诊断意义,可作为PTE早期诊断的重要手段。Objective To investigate the diagnostic value of clinical symptom scores,plasma D-dimer（ D-D） and comprehensive ultrasonography for pulmonary thromboembolism（ PTE）. Methods A total of 142 patients with PTE confirmed by CT pulmonary angiography（ CTPA） were selected as PTE group,and 68 patients suspected as PTE but excluded by CTPA were selected as non-PTE group. Before treatment,pulmonary embolism Wells score and modified Geneva score were assessed in both groups. Plasma D-D test,lower limb deep vein ultrasonography,and echocardiography were also performed. The positive rates of those indices above were compared between the two groups. The result of CTPA was taken as the golden standard,then the diagnostic efficiency of those indices above for PTE were analyzed.Results The positive rates of Wells score,modified Geneva score,plasma D-D,lower limb deep vein ultrasonography and echocardiography in the PTE group were significantly higher than those in the non-PTE group（ P〈0. 05）. The positive likelihood ratios of Wells score,modified Geneva score,plasma D-D,lower extremity deep vein ultrasonography and echocardiography for the diagnosis of PTE were all less than 10,and the negative likelihood ratios were all greater than 0. 1. Youden index of lower limb deep vein ultrasonography for the diagnosis of PTE was the highest（ 0. 6）. Conclusion Venous thrombosis diagnosed by lower limb ultrasonography obtains the greatest diagnostic significance for PTE,and can be used as an important approach for the early diagnosis of PTE.

关 键 词：肺血栓栓塞症 临床症状评分 D-二聚体 超声检查 下肢深静脉 心脏 

分 类 号：R563.5[医药卫生—呼吸系统]