Wells评分、Geneva评分和YEARS法对疑似肺栓塞住院患者诊断价值的对比研究  

Comparative study on the diagnostic value of Wells score, Geneva score and YEARS algorithm in inpatients with suspected pulmonary embolism

作　　者：刘剑 孙林[1] 向华[1] 刘觉仕[1] 张智明[1] 方志勇[1] LIU Jian;SUN Lin;XIANG Hua;LIU Jueshi;ZHANG Zhiming;FANG Zhiyong(Department of Interventional Vascular Surgery,Hunan Provincial People’s Hospital,First Affiliated Hospital of Hunan Normal University,Changsha,Hunan Province 410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)介入血管外科,长沙410005

出　　处：《介入放射学杂志》2021年第6期552-556,共5页Journal of Interventional Radiology

基　　金：湖南省自然科学基金(2017JJ2162)。

摘　　要：目的探讨Wells评分、Geneva评分和YEARS法对疑似肺栓塞(PE)住院患者的诊断价值。方法回顾性分析2017年1月至2020年6月因胸痛、呼吸困难和咯血于湖南省人民医院住院治疗的946例疑似PE患者。记录所有入组患者病史、临床表现和辅助检查结果等指标。入组患者均接受Wells评分、Geneva评分和YEARS法评估。以CT肺血管造影(CTPA)为标准,分析3种评分诊断PE的灵敏度、特异度、准确度和Youden指数,同时将3组评分结果与CTPA结果进行一致性分析,并绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估3种评分系统诊断PE价值。结果 946例患者中CTPA确诊为PE患者257例(27.2%)。Wells评分、 Geneva评分、YEARS法诊断PE灵敏度分别为88.72%、75.88%、93.00%,特异度分别为35.37%、59.36%、25.11%,准确度分别为50.11%、63.85%、43.55%,Youden指数分别为0.24、0.35、0.18。Wells评分、Geneva评分、YEARS法与CTPA的Kappa值分别为0.16、0.28、0.11。3种评分准确度两两比较差异均有显著统计学意义(P<0.01)。Wells评分、Geneva评分、YEARS法诊断PE的AUC分别为0.622±0.019、0.676±0.019、0.591±0.020,其中Geneva评分AUC最大,与Wells评分、YEARS法差异均有统计学意义(P<0.0167),Wells评分与YEARS法差异无统计学意义(P>0.0167)。结论 3种评分对疑似PE住院患者均有一定的诊断价值,Geneva评分整体诊断价值最高,Wells评分和YEARS法诊断均不理想。Objective To investigate the diagnostic value of Wells score, Geneva score and YEARS algorithm in inpatients with suspected pulmonary embolism(PE). Methods The clinical data of 946 patients with suspected PE, who were admitted to the Hunan Provincial People’s Hospital of China due to chest pain,dyspnea and hemoptysis between January 2017 and June 2020 to receive treatment, were retrospectively analyzed. The medical history, clinical manifestations and auxiliary examination results of all the enrolled patients were collected. Wells score, Geneva score and evaluation with YEARS algorithm were conducted in all patients. Taking CT pulmonary angiography(CTPA) as the gold standard, the sensitivity, specificity, accuracy and Youden index of the three evaluation scores in diagnosing PE were analyzed, and the consistencies between the evaluation scores and CTPA results in the 3 groups were analyzed, the receiver operating curve(ROC)was drawn and the area under the curve(AUC) was calculated, which were used to evaluate the diagnostic value of the three scoring systems in diagnosing PE. Results Of the 946 patients, CTPA-confirmed PE was seen in 257(27.17%). For diagnosing PE, the sensitivity of Wells score, Geneva score and YEARS algorithm was 88.72%, 75.88% and 93.00% respectively, the specificity was 35.37%, 59.36% and 25.11% respectively,the accuracy was 50.11%, 63.85% and 43.55% respectively, the Youden index was 0.24, 0.35 and 0.18 respectively, and the CTPA Kappa value was 0.16, 0.28 and 0.11 respectively. The difference in the accuracy between each other among the three methods was statistically significant(P<0.01). The AUCs of Wells score, Geneva score and YEARS algorithm were(0.622±0.019),(0.676±0.019) and(0.591±0.020)respectively;the AUC of Geneva score was the largest, which was significantly different from that of Wells score and YEARS algorithm(P<0.0167), while no statistically significant difference in AUC existed between Wells score and YEARS algorithm(P>0.0167). Conclusion For inpatients with suspected

关 键 词：CT肺血管造影 D-二聚体 肺栓塞 WELLS评分 Geneva评分 YEARS法 

分 类 号：R563.5[医药卫生—呼吸系统]