新型诊断策略--4PEPS评分对肺栓塞的临床价值  

Value of 4-level PEPS score in pulmonary embolism:a novel diagnostic strategy

作　　者：康乐琪 张晓萍[1] 邵润霞[1] KANG Leqi;ZHANG Xiaoping;SHAO Runxia(Department of Respiratory and Critical Care Medicine,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450053,China)

机构地区：[1]郑州大学第二附属医院呼吸与危重症医学科,河南郑州450053

出　　处：《中国临床研究》2023年第4期510-514,共5页Chinese Journal of Clinical Research

基　　金：河南省医学教育研究项目(Wjlx2021295)。

摘　　要：目的探讨4级肺栓塞临床概率评分(4PEPS)对肺栓塞诊断的预测价值。方法回顾性分析2019年1月至2022年3月在郑州大学第二附属医院因疑似肺栓塞行CT肺动脉造影(CTPA)检查的住院患者540例,收集患者基本临床信息及辅助检查等资料,以CTPA为金标准,比较4PEPS评分、YEARS评分、简化Wells评分联合年龄调整的D-二聚体方案(sWells-Age方案)对肺栓塞诊断的预测价值。结果540例患者中有171例经CTPA确诊肺栓塞,4PEPS评分、sWells-Age方案和YEARS评分对评估肺栓塞患者可能性的灵敏度依次为84.21%、83.04%、75.44%;特异度依次为55.28%、36.59%、47.97%;阴性预测值依次为88.31%、83.32%、80.82%。4PEPS评分的ROC曲线下面积(0.697)大于sWells-Age方案(0.598)和YEARS评分(0.617);同时4PEPS评分避免了37.78%的CTPA检查,较sWells-Age方案(25.00%)减少了12.78%,较YEARS评分(32.78%)减少了5.00%。结论4PEPS评分对肺栓塞患者的预测具有较好的临床价值,将减少37.78%的CTPA检查量,较YEARS评分、sWells-Age方案更佳,值得在临床中进一步验证。Objective To explore the predictive value of 4-level pulmonary embolism clinical probability score(4PEPS)in the diagnosis of pulmonary embolism(PE).Methods A retrospective analysis was performed on 540 inpatients who underwent CT pulmonary arteriography(CTPA)for suspected PE at the Second Affiliated Hospital of Zhengzhou University from January 2019 to March 2022.With CTPA as the gold standard,4PEPS score,YEARS score(algorithm for diagnosis of suspected PE)and simplified Wells score and age-adjusted D-dimer scheme(sWells-Age scheme)were collected to compare the predictive values of them in the diagnosis of PE.Results Of 540 inpatients,171 cases of PE were confirmed by CTPA.The sensitivities of 4PEPS score,sWells-Age scheme and YEARS score were 84.21%,83.04%and 75.44%,respectively,with the specificities of 55.28%,36.59%and 47.97%,respectively and the negative predictive values of 88.31%,83.32%and 80.82%,respectively.The area under the ROC curve of 4PEPS score(0.697)was largest,followed by YEARS score(0.617)and sWells-Age scheme(0.598)in diagnosing PE.Meanwhile,the 4PEPS score avoided 37.78%of CTPA examinations,with a decrease of 12.78%compared to the sWells-Age protocol(25.00%)and a decrease of 5.00%compared to the YEARS score(32.78%).Conclusion 4PEPS score has better application value in predicting PE.It will reduce the number of CTPA examinations by 37.78%,which is better than YEARS score and sWells-Age scheme,and is worthy of further verification in clinical practice.

关 键 词：肺栓塞 4级肺栓塞临床概率评分 诊断策略 预测价值 YEARS评分 sWell-Age方案 CT肺动脉造影 

分 类 号：R563.5[医药卫生—呼吸系统]