| 施燕.Wells与改良Geneva评分分别联合D-二聚体水平检测对肺栓塞发生风险的预测再评价分析[J].安徽医药,2018,22(11):2130-2133. |
| Wells与改良Geneva评分分别联合D-二聚体水平检测对肺栓塞发生风险的预测再评价分析 |
| Prediction and revaluation of the risk of pulmonary embolism by Wells score and the revised Geneva respectively combined with rapid plasma D-dimer assay |
| 投稿时间：2016-12-15 |
| DOI： |
| 中文关键词: 慢性阻塞性肺疾病 肺栓塞 Wells评分 Geneva评分 D-二聚体 |
| 英文关键词: Chronic obstructive pulmonary disease Pulmonary embolism Wells score Geneva score D-dimer |
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| 中文摘要: |
| 目的 比较Wells评分与改良Geneva评分以及两者分别联合血浆D-二聚体检测对慢性阻塞性肺疾病急性加重期住院患者肺栓塞发生风险的预测效能。方法 选择安徽省立医院西区2013年1月至2016年1月诊断为慢性阻塞性肺疾病急性加重住院的362例患者。收集患者一般资料、凝血象、D-二聚体等相关数据,并进行Wells评分和改良Geneva评分,比较两种评分方法以及两种评分方法结合D-二聚体水平的ROC曲线下面积,评估各方法对慢性阻塞性肺疾病急性加重期肺栓塞风险的预测效能。结果 Wells评分＜2分确诊肺栓塞的可能性为0.6%,2～6分的可能性为5％,而>6分其可能性则为100%。改良Geneva评分≤3分的患者其诊断肺栓塞的低度可能性为2.2%,4～10分的中度可能性为4.5%,而≥11分的高度可能性则为62.5%。Wells评分的ROC曲线下面积AUC为0.86(95%CI:0.82～0.95),最佳分界值为3.75；改良Geneva评分的ROC曲线下面积为0.82(95%CI:0.70～0.93),最佳分界值为6.5分,两ROC曲线下面积AUC比较差异无统计学意义(P=0.51)。Wells评分联合D-二聚体时,低度风险的阴性预测值为100.0%,但中、高度风险的阳性预测值为6.8%；Geneva评分联合D-二聚体时,低度风险的阴性预测值为100.0%,中、高度风险的阳性预测值为5.9%。 结论 Wells评分和改良Geneva评分对肺栓塞的预测均具有较高的临床价值,两种评分联合D-二聚体检测对于排除慢性阻塞性肺疾病急性加重患者发生肺栓塞更加有效。 |
| 英文摘要: |
| Objective To compare the predictive efficacy of the Wells score,the revised Geneva score,and their respective combination of rapid plasma D-dimer assay for the risk of pulmonary embolism (PE) in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).Methods Three hundred and twenty-six cases of patients with acute exacerbation of COPD in West Area of Anhui Provincial Hospital from January 2013 to January 2016 were selected as the research subjects.Patients' relevant data,such as general information,the blood clotting,D-dimer et al,were collected and assessed by the Wells score and the revised Geneva score.ROC curves of the Wells score,the revised Geneva scores,and their respective combination of rapid plasma D-dimer assay were compared,and the predictive efficacy of the Wells score,the revised Geneva score,and their combination of rapid plasma D-dimer assay for the risk of pulmonary embolism in patients with acute exacerbation of COPD were evaluated.Results The possibilities to confirm PE were 0.6% (Wells score<2 points),5% (Wells score:2 to 6 points),and 100% (Wells score>6 points).The possibilities to confirm PE were 2.2% (revised Geneva score≤3 points),4.5% (revised Geneva score:4 to 10 points),and 62.5% (revised Geneva score≥11 points).The area under curve (AUC) of the ROC curve in the Wells and Geneva scores were 0.86(95% CI:0.82 to 0.95) and 0.82(95% CI:0.70 to 0.93),respectively.The best cut off value was 3.75 points in the Wells score and 6.5 points in the revised Geneva score.The comparison of the area under curve between the Wells and the revised Geneva scores had no significant difference (P=0.51).When combining Wells score with D-dimer,the negative predictive value of PE was 100.0% in low risk,but the positive predictive value of PE was 6.8% in intermediate and high risk;when combining the revised Geneva score with D-dimer,the negative predictive value was 100.0% in low risk,and the positive predictive value of PE was 5.9% in intermediate and high risk.ConclusionThe Wells score and the revised Geneva score are valuable in prediction of PE,and it's safer and more effective to combine both scores with D-dimer in ruling out PE in patients with acute exacerbation of COPD. |
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