比较YEARS评分与简化Wells联合年龄校正D-二聚体评分用于疑似肺栓塞患者的诊断价值  

Diagnostic value of YEARS score and simplified Wells combined with age-corrected D-dimer score in patients with suspected pulmonary embolism

作　　者：谭笑 郭燕妮 TAN Xiao;GUO Yanni(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646099,China;Health Management Center,Yibin Second People′s Hospital of Sichuan Province,Yibin,Sichuan 644002,China)

机构地区：[1]西南医科大学附属医院呼吸与危重症医学科,四川泸州646099 [2]宜宾市第二人民医院健康管理中心,四川宜宾644002

出　　处：《临床肺科杂志》2024年第12期1838-1843,共6页Journal of Clinical Pulmonary Medicine

基　　金：四川省医学会医学研究课题(No.S20081)。

摘　　要：目的通过前瞻性研究比较YEARS评分与简化Wells联合年龄校正D-二聚体评分(sWells-Age)用于疑似肺栓塞患者的诊断价值。方法纳入2021年3月3日到2022年4月30日于宜宾市第二人民医院就诊且符合纳排标准的可疑肺栓塞病人522名,采用前瞻性观察研究,由临床医师对照YEARS评分收集患者基线信息,计算患者YEARS评分及sWells-Age评分判断其目前肺栓塞临床可能性。所有排除肺栓塞且未进行抗凝治疗的患者进行3个月随访。以CTPA检查结果作为诊断金标准,分别计算YEARS评分及sWells-Age评分敏感度、特异度、κ值等指标,绘制两者ROC曲线并计算AUC值。结果sWells-Age评分及YEARS评分灵敏度分别为85.71%、93.41%(P<0.001),特异度分别为69.23%、56.92%(P<0.001),AUC值分别为0.775(95%CI 0.688~0.816)、0.752(95%CI 0.711~0.838),与CTPA的κ值分别为0.526、0.465,均>0.410,结果一致性均属于中等,两者灵敏度比较(χ^(2)=5.143,P<0.025),差异具有统计学意义,两者特异度比较(χ^(2)=12.500,P<0.001),差异具有显著统计学意义。结论sWells-Age评分优于YEARS评分,但YEARS评分项目少,灵敏度及安全性高,可应用于早期肺栓塞患者的筛查。Objective To compare the diagnostic value of YEARS score and simplified Wells combined with age-corrected D-dimer score(sWells-Age)in patients with suspected pulmonary embolism(PE).Methods A total of 522 patients with suspected pulmonary embolism who met the inclusion and exclusion criteria in the Second People′s Hospital of Yibin from March 3,2021 to April 30,2022 were enrolled in this prospective observational study.The YEARS score and sWells-Age score were calculated to assess the clinical likelihood of PE.All patients who were excluded from pulmonary embolism and did not receive anticoagulant therapy were followed up for 3 months.Taking CTPA results as the diagnostic gold standard,the sensitivity,specificity,κvalue and other indicators of the YEARS score and sWells-Age score were calculated,respectively.The ROC curves of the two scores were drawn and the AUC value was calculated.Results The sensitivity of sWells-Age score and YEARS score were 85.71%and 93.41%,respectively(P<0.001),and the specificity were 69.23%and 56.92%,respectively(P<0.001).The AUC values were 0.775(95%CI 0.688~0.816)and 0.752(95%CI 0.711~0.838),respectively,and theκvalues with CTPA were 0.526 and 0.465,respectively(all>0.410),and the consistency of the results was moderate.There were significant differences in sensitivity(χ^(2)=5.143,P<0.025)and specificity(χ^(2)=12.500,P<0.001)between the two groups.Conclusion The sWells-Age score is better than the YEARS score,but the YEARS score has fewer items,higher sensitivity and safety,which can be applied to screen patients with early pulmonary embolism.

关 键 词：肺栓塞 YEARS评分 简化Wells评分 年龄校正 D-二聚体 

分 类 号：R563.5[医药卫生—呼吸系统]