三种评分体系对急性肺血栓栓塞症预后评估的比较  

Comparative study of three clinical scoring systems in patients with acute pulmonary thromboembolism

作　　者：王晓芳[1] 张运剑[1] 刘春萍 Wang Xiaofang;Zhang Yunjian;Liu Chunping(Department of Respiratory and Critical Care Medicine,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Cardiology,Beijing Army General Hospital,Beijing 100700,China)

机构地区：[1]北京积水潭医院呼吸与危重症医学科,100035 [2]陆军总医院心内科,北京100700

出　　处：《中华急诊医学杂志》2018年第10期1158-1163,共6页Chinese Journal of Emergency Medicine

基　　金：北京市科学技术委员会资助课题（Z141107002514153）

摘　　要：目的比较简化改良版Geneva预后评分（sGPS）、肺栓塞严重度指数（PESI）及简化肺栓塞严重度指数（sPESI）对急性肺血栓栓塞症（PTE）患者的预后评估价值。方法采用回顾性队列研究方法，将北京积水潭医院1997年1月至2016年12月确诊的276例急性肺血栓栓塞症（PTE）患者，根据sGPS、PESI、sPESI分别分为低危组和高危组，以30d病死率为预后指标，通过受试者工作特征曲线（ROC）评估各评分体系对预后的预测价值。结果（1）276例急性PTE患者的30d总病死率为22，5％，sGPS、PESI、sPESI低危组及高危组患者的30d病死率分别为7．6％vs．47．1％、1．0％vs．34．3％、2．4％vs．30．9％，其中高危组患者的30d病死率均显著高于低危组患者（均P〈0．01）；sGPS及PESI低危组患者的30d病死率之间具差异有统计学意义（P=0．020），sGPS与PESI、sPESI高危组患者的30d病死率之间差异均有统计学意义（P=0．033，P=0．006）。（2）sGPS、PESI、sPESI评估急性PTE患者30d预后的ROC曲线下面积（AUC）分别为0．824、0．891、0．846；其中PESI评分的特异度（84．6％）、准确度（84．4％）及阳性预测值（61．2％）最高，同时也具有较高的敏感度（83．9％）及阴性预测值（94．8％），而sPESI评分的阴性预测值（98．6％）最高。结论PESI评分能够更准确地对急性PTE患者进行总体危险分层，而sPESI评分则更有助于识别可早期出院的急性PTE患者。Objective To compare the prognostic value of simplified revised Geneva Prognostic Score （sGPS）, Pulmonary Embolism Severity Index （PEsI） and simplified Pulmonary Embolism Severity Index （sPESI） in patients with acute pulmonary thromboembolism（PTE）. Methods A retrospective cohort study was carried out on 276 consecutive patients with identified acute PTE admitted to our hospital from January 1997 to December 2016. We dichotomized patients as low vs, high risk in all three scoring systems. The 30-day mortality of the patients were used as prognostic factors. The prognostic value of each scoring system was evaluated by the area under the receiver operating characteristic curve（ROC）. Results （1） The overall 30-day mortality of 276 patients with acute PTE was 22.5%. The 30-day mortality of patients in low vs. high risk groups according to sGPS, PESI and sPESI were 7.6% vs. 47.1%, 1.0% vs. 34.3%, 2.4% vs. 30.9%, respectively. The 30-day mortality of patients in high risk groups according to sGPS, PESI and sPESI were significantly higher than those of patients in low risk groups（P〈0.01）. The 30-day mortality of patients in low risk groups according to sGPS and PESI were significantly different（P=0.020）. The 30-day mortality of patients in high risk groups according to sGPS were significantly different from those of patients in high risk groups according to PESI and sPESI, respectively （P=0.033, P=0.006）. （2） The areas under the receiver operating characteristic （ROC） curves for evaluating the prognosis of patients with acute PTE according to sGPS, PESI and sPESI were 0.824, 0.891 and 0.846, respectively. The specificity （84.6%）, the accuracy （84.4%） and the positive predictive value （61.2%） of PESI were the highest among the three prediction rules, the sensitivity （83.9%） and the negative predictive value （94.8%） of PESI were also relatively high. The negative predictive value of sPESI （98.6%） was the highest among the three prediction rules. Conclusi

关 键 词：肺血栓栓塞症 简化改良版Geneva预后评分 肺栓塞严重度指数 简化肺栓塞严重度指数 危险分层 

分 类 号：R563.5[医药卫生—呼吸系统]