简化版Wells评分、修订版Geneva评分和D-二聚体水平在恶性肿瘤并发肺血栓栓塞症诊断中的应用价值  

Application values of simplified Wells score, revised Geneva score and D-dimer level in diagnosis of malignant tumor complicated with pulmonary thromboembolism

作　　者：王聪[1,2] 郭秀 迟昊 张捷 许溟宇[1] 董春玲[1] WANG Cong;GUO Xiu;CHI Hao;ZHANG Jie;XU Mingyu;DONG Chunling(Department of Respiratory and Critical Care Medicine,Second Hospital,Jilin University,Changchun 130041,China;Department of Respiratory and Critical C-are Medicine,Heze Municipal Hospital,Shandong Province,Heze 274000,China)

机构地区：[1]吉林大学第二医院呼吸与危重症医学科,吉林长春130041 [2]山东省菏泽市立医院呼吸与危重症医学科,山东菏泽274000

出　　处：《吉林大学学报（医学版）》2021年第3期707-713,共7页Journal of Jilin University：Medicine Edition

基　　金：国家科技部科研基金项目(2016YFC0905600)。

摘　　要：目的:探讨简化版Wells评分、修订版Geneva评分和D-二聚体(DD)水平在恶性肿瘤并发肺血栓栓塞症(PTE)诊断中的应用价值,为临床诊断PTE提供参考。方法:回顾性分析疑似诊断为PTE并行CT肺动脉造影(CTPA)检查的142例恶性肿瘤患者的临床资料,依据CTPA结果将72例恶性肿瘤并发PTE患者作为PTE组,70例不并发PTE患者为非PTE组,对2组患者形成PTE的相关风险因素进行统计分析,绘制受试者工作特征曲线(ROC曲线),采用Z检验比较上述评分的ROC曲线下面积(AUC),评价其在恶性肿瘤并发PTE诊断中的应用价值。结果:病理类型为腺癌、肿瘤发生转移、并发深静脉血栓(DVT)和DD阳性是恶性肿瘤患者发生PTE的独立危险因素(P<0.05);简化版Wells评分、修订版Geneva评分和DD水平的灵敏度分别为87.5%、87.5%及97.2%,阴性预测值分别为74.3%、70.0%及83.3%,上述2种评分量表与DD水平联合评价的灵敏度均为100%,漏诊率较低,且其阴性预测值可达100%,排除价值较大;简化版Wells评分、修订版Geneva评分、DD水平、修订版Geneva评分联合DD水平和简化版Wells评分联合DD水平的AUC分别为0.762、0.687、0.649、0.741及0.786,简化版Wells评分联合DD水平的AUC最大,大于其他种类量表(P<0.05)。结论:简化版Wells评分联合DD水平对恶性肿瘤并发PTE患者诊断更具有参考价值。Objective:To explore the application values of simplified Wells score,revised Geneva score,and D-dimer(DD)level in the diagnosis of malignant tumor complicated with pulmonary thromboembolism(PTE),and to provide the reference for PTE diagnosis in clinic.Methods:The clinical data of 142 cases of malignant tumor patients suspected of PTE and underwent CT pulmonary angiography(CTPA)examination were analyzed retrospectively.The diagnosis of PTE was based on the results of CTPA,and 72 patients with malignant tumor complicated with PTE were regarded as PTE group and 70 patients with malignant tumor without PTE were regarded as non-PTE group.The risk factors of all the enrolled patients were investigated through the statistical analysis,the receiver operating characteristic curves(ROC curves)were generated and the Z test was applied to compare the area under the ROC curve(AUC)of the above scores,and their values in the dignosis of malignant tumor complicated with PTE were evaluated.Results:Adenocarcinoma,tumor metastasis,deep venous thrombosis(DVT)and positive DD were the independent risk factors for PTE in the patients with malignant tumor(P<0.05).The sensitivities of simplified Wells score,revised Geneva score,and DD level were 87.5%,87.5%,and 97.2%,respectively;the negative predictive values were 74.3%,70.0%,and 83.3%,respectively.The sensitivities of the two clinical score scales combined with DD level reached 100%,the misdiagnostic rate was lower,and the negative predictive value reached 100%which was of great value for exclusion.The AUC of simplified Wells score,revised Geneva score,DD level,revised Geneva score combined with DD level,and simplified Wells score combined with DD level were 0.762,0.687,0.649,0.741,and 0.786,respectively.The AUC of simplified Wells score combined with DD level was the greatest,which was larger than those of the other scales(P<0.05).Conclusion:Simplified Wells score combined with DD level shows a higher value in the diagnosis of malignant tumor complicated with PTE.

关 键 词：恶性肿瘤 肺血栓栓塞症 简化版Wells评分 修订版Geneva评分 D-二聚体 

分 类 号：R563.5[医药卫生—呼吸系统]