标准法、AADD、YEARS、PERC及PEGeD对慢性阻塞性肺疾病并疑诊肺栓塞患者的预测价值比较  

Comparison of the predictive value of standard method,AADD,YEARS,PERC,and PEGeD in patients with chronic obstructive pulmonary disease and suspected pulmonary embolism

作　　者：张鸿腾 吕茹 裴硕 樊芳芳[1] 冉博文 胡晓芸[1] ZHANG Hong-teng;LÜ Ru;PEI Shuo;FAN Fang-fang;RAN Bo-wen;HU Xiao-yun(Department of Respiratory and Critical Care Medicine,First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030000,China)

机构地区：[1]山西医科大学第一医院呼吸与危重症医学科,山西太原030000

出　　处：《临床肺科杂志》2022年第11期1659-1662,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨标准法、AADD(age-adjusted D-dimer)、YEARS、PERC(pulmonary embolism rule-out criteria)及PEGeD(pulmonary embolism graduated d-Dimer)5种肺栓塞风险评估方法,对住院慢性阻塞性肺疾病急性加重期(AECOPD)并疑诊PE患者的预测价值。方法纳入116例因AECOPD住院并疑诊PE患者。以CTPA和/或V/Q的阳性结果作为确诊PE的金标准,使用标准法、AADD、YEARS、PERC及PEGeD5种方法对入组患者进行评估,比较上述评估方法的预测价值。结果116例住院AECOPD疑诊PE患者中确诊PE者共45例,确诊率为38.8%。标准法、AADD、YEARS、PEGeD对住院AECOPD疑诊PE患者的灵敏度、阳性预测值、阳性似然比、特异度、阴性预测值、阴性似然比、Youden指数分别为:(93.3%、45.2%、1.30、28.2%、87.0%、0.24、0.22)、(66.7%、71.4%、3.94、83.1%、79.7%、0.40、0.50)、(60.0%、77.1%、5.33、88.7%、77.8%、0.45、0.49)、(81.6%、70.2%、3.71、76.1%、91.5%、0.15、0.58)。PERC的灵敏度、阳性预测值分别为:(100%、100%)。PEGeD对于住院AECOPD疑诊PE患者的真阳性率、阴性预测值高,总体预测价值明显优于其余四种方法。结论PEGeD在上述5种方法中最适合住院AECOPD患者进行PE预测。Objective To explore the predictive value of five pulmonary embolisms(PE)risk assessment methods including standard method,AADD(age-adjusted D-dimer),YEARS,PERC(pulmonary embolism rule-out criteria),and PEGeD(pulmonary embolism graduated d-Dimer)for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and suspected PE.Methods A total of 116 patients hospitalized for AECOPD with suspected PE were included.The positive results of CTPA and/or V/Q were used as the gold standard for the diagnosis of PE,and five methods including standard method,AADD,YEARS,PERC,and PEGeD were used to evaluate the enrolled patients,and the predictive value of the above evaluation methods was compared.Results Amongthe 116 hospitalized AECOPD patients with suspected PE,45(38.8%)were diagnosed with PE,and the confirmed rate was 38.8%.The sensitivity,positive predictive value,positive likelihood ratio,specificity,negative predictive value,negative likelihood ratio,and Youden index of standard method,AADD,YEARS,and PEGeD for hospitalized AECOPD patients with suspected PE were:(93.3%,45.2%,1.30,28.2%,87.0%,0.24,0.22)、(66.7%,71.4%,3.94,83.1%,79.7%,0.40,0.50)、(60.0%,77.1%,5.33,88.7%,77.8%,0.45,0.49)、(81.6%,70.2%,3.71,76.1%,91.5%,0.15,0.58),respectively.The sensitivity and negative predictive value of PERC were(100%,100%).The true positive rate and negative predictive value of PEGeD for hospitalized AECOPD patients with suspected PE were high,and the overall predictive value was significantly better than the other four methods.Conclusion PEGeD is the most suitable method for predicting PE in hospitalized AECOPD patients among the above five methods.

关 键 词：慢性阻塞性肺疾病急性加重期 肺栓塞 AADD YEARS PEGeD 

分 类 号：R563[医药卫生—呼吸系统]