Wells评分联合血栓弹力图快速预测慢性阻塞性肺疾病急性加重并发肺栓塞的研究  

A study on the combination of Wells score and thromboelastography for rapid prediction of acute exacerbation of COPD complicated with pulmonary embolism

作　　者：陆薇[1] 关小勇[1] 梁明燕 莫道章 覃灏[1] 孔晋亮[2] LU Wei;GUAN Xiaoyong;LIANG Mingyan;MO Daozhang;QIN Hao;KONG Jinliang(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Guangxi University of Science and Technology,Liuzhou,Guangxi 545000,P.R.China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi,530021,P.R.China)

机构地区：[1]广西科技大学第一附属医院呼吸与危重症医学科,广西柳州545000 [2]广西医科大学第一附属医院呼吸与危重症医学科,广西南宁530021

出　　处：《中国呼吸与危重监护杂志》2025年第3期186-191,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2021122);柳州市科技计划项目(2024YB0101B015)。

摘　　要：目的探究和分析Wells评分联合血栓弹力图(thromboelastography,TEG)快速预测慢性阻塞性肺疾病(简称慢阻肺)急性加重并发肺栓塞的临床价值。方法选择广西科技大学第一附属医院呼吸与危重症医学科自2022年1月—2023年3月收治的130例慢阻肺急性加重患者作为研究对象,根据肺动脉数字减影血管造影检查结果分为肺栓塞组为37例,非肺栓塞组为93例,两组患者均行Wells评分联合TEG,对比两组患者Wells评分、凝血反应时间(reaction time,R时间)、血凝块形成时间(kinetic time,K时间)、综合凝血指数(coagulation index,CI)、最大振幅(maximum amplitude,MA)等TEG参数,以及对比单用Wells评分、TEG及Wells评分联合TEG等不同预测模型诊断慢阻肺急性加重并发肺栓塞的敏感性、特异性和受试者操作特征曲线下面积(area under curve,AUC)。结果肺栓塞组患者Wells评分高于非肺栓塞组,肺栓塞组患者R时间低于非肺栓塞组,肺栓塞组患者K时间、CI、MA等参数水平高于非肺栓塞组(均P<0.05)。Wells评分联合TEG预测模型诊断慢阻肺急性加重并发肺栓塞的敏感性、特异性和AUC大于Wells评分预测模型。结论Wells评分联合TEG快速预测慢阻肺急性加重并发肺栓塞的临床价值显著,值得临床应用和推广。Objective To explore the clinical value of Wells score combined with thromboelastography(TEG)in rapid prediction of pulmonary embolism(PE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 130 AECOPD patients admitted to the Department of Respiratory and Critical Care Medicine of Guangxi University of Science and Technology from January 2022 to March 2023 were selected as the study subjects.According to results of digital subtraction angiography(DSA)of the pulmonary artery,the patients were divided into a PE group(n=37)and a non-PE group(n=93).Both groups underwent Wells score analysis combined with TEG.Thromboelastographic parameters were comparing between the two groups,including Wells score,reaction time(R time),reaction time(K time),coagulation index(CI),and maximum amplitude(MA).The diagnostic value of different prediction models to diagnose AECOPD with PE was compared,including Wells score,thromboelogram and Wells score combined with TEG.Results The Wells score of the patients in the PE group was significantly higher than that in the non-PE group,and R time of the patients in the PE group was significantly lower than that in the non-PE group.The K time,CI,MA and other parameter levels of the patients in the PE group were significantly higher than those in the non-PE group(all P<0.05).The sensitivity,specificity,and area under ROC curve of the combination of Wells score and TEG prediction model in diagnosing AECOPD complicated with PE were greater than those of the Wells score alone prediction model(P<0.05).Conclusion The combination of Wells score and TEG has significant clinical value in quickly predicting AECOPD complicated with PE,and is worthy of clinical application and promotion.

关 键 词：慢性阻塞性肺疾病 急性加重 肺栓塞 WELLS评分 血栓弹力图 预测 

分 类 号：R56[医药卫生—呼吸系统]