Padua评分联合D-二聚体检测对慢性肺部疾病患者静脉血栓栓塞症的诊断价值  

The diagnostic values of Padua score combined D-Dimer for venous thromboembolism in patients with chronic pulmonary diseases

作　　者：盛海燕[1] 刘晓芳[1] 金建敏[1] 胥杰[1] 刘涌[1] Sheng Haiyan;Liu Xiaofang;Jin Jianmin;Xu Jie;Liu Yong(Department of Respiratory Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院呼吸科,100730

出　　处：《国际呼吸杂志》2020年第1期30-36,共7页International Journal of Respiration

摘　　要：目的探讨Wells评分、修正的Geneva评分、Padua评分及血浆D-二聚体对慢性肺部疾病患者静脉血栓栓塞症(VTE)的诊断价值。方法回顾性分析2012年1月至2018年12月首都医科大学附属北京同仁医院呼吸科135例慢性肺部疾病住院患者的临床资料。采用3种评分系统对患者进行VTE的诊断评估及危险分层,根据影像学结果将患者分为VTE组(50例)与无VTE组(85例),比较2组间临床资料差异。采用受试者工作特征曲线的曲线下面积(AUC)比较3种评分系统及血浆D-二聚体对慢性肺部疾病患者VTE的诊断价值,计算约登指数,得出cut-off值。结果本研究共入组慢性肺部疾病患者135例,合并VTE50例,VTE发生率3704%。VTE组D-二聚体水平高于无VTE组[M(QR)为2335(6670)μg/L比400(870)μg/L,Z=-6026,P【0001]。Wells评分诊断的AUC为0681±0049,95%CI:0584~0777。修正的Geneva评分诊断VTE的AUC为0614±0051,95%CI:0515~0713。Padua评分诊断VTE的AUC为0795±0042,95%CI:0713~0877。D-二聚体诊断VTE的AUC为0811±0039,95%CI:0735~0873。Padua评分诊断的cut-off值为3分,约登指数为0497。D-二聚体诊断的cut-off值为1460μg/L,约登指数为0519。Padua评分与血浆D-二聚体联合诊断的准确性高于单独Padua评分(P=0009)及D-二聚体(P=0087)。结论Padua评分联合血浆D-二聚体对慢性肺部疾病患者VTE的诊断价值较高,可为患者适时、合理、规范地选择影像学确诊检查提供参考,降低漏诊率及误诊率,并节约医疗资源。Objective To explore the diagnostic values of the Wells score,the revised Geneva score,the Padua score and the D-dimer level for venous thrombus embolism(VTE)in hospitalized patients with chronic pulmonary diseases.Methods The clinical data of inpatients with chronic pulmonary diseases(n=135)at department of respiratory medicine in Beijing Tongren Hospital from January 2012 to December 2018 were analyzed retrospectively.The Wells score,revised Geneva score and Padua score were calculated to evaluate the diagnosis and risk stratification of VTE.and the patients were divided into VTE group(n=50)and non-VTE group(n=85)according to the imaging results,and the clinical data between the two groups were compared.The diagnostic value of the three scoring systems and D-dimer level were compared by the area under the receiver operating characteristic(ROC)curve,and the Youden Index was calculated for the cut-off point.Results The incidence of VTE in patients with chronic pulmonary diseases was 37.04%.The D-Dimer level in VTE group was higher than that in non-VTE group:2335(6670)μg/L vs 400(870)μg/L,P<0.001].The area under curve(AUC)of the ROC in Wells score,revised Geneva score,Padua score and the D-dimer level was 0.681±0.049,0.614±0.051,0.795±0.042,0.811±0.039,separately.The cut-off of Padua score was 3 points and Youden Index was 0.497.The cut-off of D-dimer level was 1460 μg/L and Youden Index was 0.519.The AUC of Padua score combined with D-dimer(0.865±0.034)was higher than that of Padua(P=0.009)or D-dimer(P=0.087),separately.Conclusions The index of Padua score combined with plasma D-dimer has the highest value in the diagnosis of VTE in patients with chronic pulmonary diseases,which can provide reference for timely,reasonable and standardized selection of imaging diagnosis,and further to improve the diagnostic accuracy and optimize the allocation of medical resources.

关 键 词：静脉血栓栓塞 诊断 肺疾病 

分 类 号：R54[医药卫生—心血管疾病]