Wells评分联合D―dimer在急性肺栓塞诊断临床预测价值.docVIP

Wells评分联合D―dimer在急性肺栓塞诊断临床预测价值 　　DOI：10.3760/cma.j.issn.1671-0282.2015.04.019 　　作者单位：100020 北京，首都医科大学附属北京朝阳医院急诊科 （腾飞、何新华、李春盛）;北京市顺义区医院急诊科（李彦媚、杨杰） 　　通信作者：何新华，Email：xhhe2000@yeah.net 　　【摘要】目的 评价Wells评分联合D-dimer在急性肺栓塞诊断的临床预测价值。方法 收集2008年至2011年就诊北京朝阳医院急诊科疑似肺栓塞患者540例，以CTPA检查阳性为确诊肺栓塞的依据，分为肺栓塞（PE）组与非肺栓塞（Non-PE）组，对两组患者在人口学特征、基础疾病、主诉、体征、静脉血栓危险因素、相关实验室检查、Wells评分等进行比较和统计学分析。结果 最终入选患者502例，PE组246例，Non-PE组256例，近期术后或卧床、近期骨盆或下肢骨折、咯血、一过性意识障碍、单侧下肢肿胀、低氧低碳酸血症、D-dimer升高、高危Wells评分等在PE组出现的频率显著高于Non-PE组，Plt;0.05，其他参数在两组中差异无统计学意义。Wells评分、D-dimer值及二者联合的ROC曲线下面积分别是0.775（95%CI： 0.719～0.831），0.802（95%CI： 0.751～0.853），0.899（95%CI： 0.834～0.964），二者联合ROC曲线下面积大于二者单独应用，Plt;0.05。截点值Wells评分5分，D-dimer 1 724.00 μg/L为敏感度与特异度加权最大值，超过截点值时，诊断PE的可靠性明显提高;低于截点值时，排除PE的可靠性也明显升高。结论 Wells评分联合D-Dimer检查比单独应用在急性肺栓塞预测中更具备临床价值。 　　【关键词】急性肺栓塞;Wells评分;D-dimer;临床预测 　　The predictive value of Wells score combined with D-dimer in the diagnosis of acute pulmonary embolism 　　Teng Fei*， He Xinhua，Li Yanmei， Yang Jie， Li Chunsheng*. Emergency Department，Beijing Chaoyang Hospital， Capital Medical University， Beijing 100020， China 　　Corresponding author：He Xinhua， Email：xhhe2000@yeah.net 　　【Abstract】Objective To evaluate the predictive value of Wells score combined with D-dimer in the diagnosis of acute pulmonary embolism. Methods A total of 540 patients with suspected pulmonary embolism admitted from 2008 to 2011 were enrolled for study. The diagnosis of pulmonary embolism （PE） was confirmed by using computed tomography pulmonary angiography（CTPA）. These patients were divided into two groups： PE group and non-PE group. Comparative analysis was carried out in demographics， underlying diseases， chief complaints， physical signs， venous thrombosis risk factors， laboratory findings and Wells scores between the two groups. Results Of 502 patients selected into this study， there were 246 in PE group and 256 in Non-PE group. The incidence rates of history of recent surgery or bed-ridden， recent fracture of pelvis or lower limb， s