[1]刘 剑,孙 林,向 华,等.Wells评分、Geneva评分和YEARS法对疑似肺栓塞住院患者诊断价值的对比研究[J].介入放射学杂志,2021,30(06):552-556.
 LIU Jian,SUN Lin,XIANG Hua,et al.Comparative study on the diagnostic value of Wells score, Geneva score and YEARS algorithm in inpatients with suspected pulmonary embolism[J].journal interventional radiology,2021,30(06):552-556.
点击复制

Wells评分、Geneva评分和YEARS法对疑似肺栓塞住院患者诊断价值的对比研究()

PDF下载中关闭

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
30
期数:
2021年06
页码:
552-556
栏目:
血管介入
出版日期:
2021-06-26

文章信息/Info

Title:
Comparative study on the diagnostic value of Wells score, Geneva score and YEARS algorithm in inpatients with suspected pulmonary embolism
作者:
刘 剑;  孙 林;  向 华;  刘觉仕;  张智明;  方志勇
Author(s):
LIU Jian;  SUN Lin;  XIANG Hua;  LIU Jueshi;  ZHANG Zhiming;  FANG Zhiyong.
Department of Interventional Vascular Surgery, Hunan Provincial People’s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province 410005, China
关键词:
【关键词】 CT肺血管造影;  D-二聚体; 肺栓塞;  Wells评分;  Geneva评分;  YEARS法
文献标志码:
A
摘要:
【摘要】 目的 探讨Wells评分、Geneva评分和YEARS法对疑似肺栓塞(PE)住院患者的诊断价值。方法 回顾性分析2017年1月至2020年6月因胸痛、呼吸困难和咯血于湖南省人民医院住院治疗的946例疑似PE患者。记录所有入组患者病史、临床表现和辅助检查结果等指标。入组患者均接受Wells评分、Geneva评分和YEARS法评估。以CT肺血管造影(CTPA)为标准,分析3种评分诊断PE的灵敏度、特异度、准确度和Youden指数,同时将3组评分结果与CTPA结果进行一致性分析,并绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估3种评分系统诊断PE价值。结果 946例患者中CTPA确诊为PE患者257例(27.2%)。Wells评分、 Geneva评分、YEARS法诊断PE灵敏度分别为88.72%、75.88%、93.00%,特异度分别为35.37%、59.36%、25.11%,准确度分别为50.11%、63.85%、43.55%,Youden指数分别为0.24、0.35、0.18。Wells评分、Geneva评分、YEARS法与CTPA的Kappa值分别为0.16、0.28、0.11。3种评分准确度两两比较差异均有显著统计学意义(P<0.01)。Wells评分、Geneva评分、YEARS法诊断PE的AUC分别为0.622±0.019、0.676±0.019、0.591±0.020,其中Geneva评分AUC最大,与Wells评分、YEARS法差异均有统计学意义(P<0.0167),Wells评分与YEARS法差异无统计学意义(P>0.0167)。 结论 3种评分对疑似PE住院患者均有一定的诊断价值,Geneva评分整体诊断价值最高,Wells评分和YEARS法诊断均不理想。

参考文献/References:

[1] Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboem-bolism(VTE) in Europe. The number of VTE events and associated morbidity and mortality[J]. Thromb Haemost, 2007, 98: 756-764.
[2] Righini M, Robert-Ebadi H, Le Gal G. Diagnosis of acute pulmonary embolism[J]. J Thromb Haemost, 2017, 15: 1251-1261.
[3] Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society(ERS): the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology(ESC)[J]. Eur Respir J, 2019, 54: 1901647.
[4] Howard LSGE, Barden S, Condliffe R, et al. British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism(PE)[J]. Thorax, 2018, 73(Suppl 2): ii1-ii29.
[5] Tran HA, Gibbs H, Merriman E, et al. New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboem-bolism[J]. Med J Aust, 2019, 210: 227-235.
[6] van der Hulle T, Cheung WY, Kooij S,et al. Simplified diagnostic management of suspected pulmonary embolism(the YEARS study): a prospective, multicentre, cohort study[J]. Lancet, 2017, 390: 289-297.
[7] Gallus A. Simplified and original Wells rules plus age-adjusted D-dimer test were useful for ruling out suspected PE[J]. Ann Intern Med, 2017, 166: JC71.
[8] Klok FA, Kruisman E, Spaan J, et al. Comparison of the revised Geneva score with the Wells rule for assessing clinical probability of pulmonary embolism[J]. J Thromb Haemost, 2008, 6: 40-44.
[9] 王 辰. 2018年肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018, 98:1060-1087.
[10] 刘 磊,徐 克,肖 亮. 肺动脉血栓栓塞的影像诊断新进展及介入治疗研究[J]. 介入放射学杂志, 2009, 18:60-62.
[11] Chan K, Lang E. In pregnant women, the pregnancy-adapted YEARS algorithm ruled out PE, with a low rate of VTE at 3 months[J]. Ann Intern Med, 2019, 171: JC23.
[12] Langlois E, Cusson-Dufour C, Moumneh T, et al. Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT-PE-pregnancy study[J]. J Thromb Haemost, 2019, 17: 1329-1334.
[13] Abdelaal Ahmed Mahmoud M Alkhatip A, Donnelly M, Snyman L, et al. YEARS algorithm versus wells’score: predictive accuracies in pulmonary embolism based on the gold standard CT pulmonary angiography[J]. Crit Care Med, 2020, 48: 704-708.
[14] Shen JH, Chen HL, Chen JR, et al. Comparison of the wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis[J]. J Thromb Thrombolysis, 2016, 41: 482-492.
[15] Gruettner J, Walter T, Lang S, et al. Importance of wells score and Geneva score for the evaluation of patients suspected of pulmonary embolism[J]. In Vivo, 2015, 29: 269-272.
[16] 赵 莹,孟 杰,冷 琦. 简化Wells评分、简化Geneva评分在疑似肺栓塞住院患者中的应用[J]. 中国医刊, 2016, 51:62-65.
[17] 荆文花,李鸿宇,关英慧. Wells评分和YEARS法对肺栓塞诊断价值的比较[J]. 吉林大学学报(医学版), 2019, 45:88-93.
[18] 洪 都,徐 军,王春英,等. 两种量表预测D-二聚体异常患者肺栓塞形成的效果比较[J]. 中华现代护理杂志, 2019, 25:439-443.
[19] Tsimogianni AM, Rovina N, Porfyridis I, et al. Clinical prediction of pulmonary embolism in respiratory emergencies[J]. Thromb Res, 2011, 127: 411-417.
[20] Konstantinides SV. Diagnosis of pulmonary embolism: progress after many YEARS[J]. Lancet, 2017, 390: 210-211.

相似文献/References:

[1]赵伯翔,顾建平,陈国平,等. D-二聚体监测在治疗急性髂股静脉血栓形成中的临床价值[J].介入放射学杂志,2013,(06):464.
 ZHAO Bo? xiang,GU Jian? ping,CHEN Guo? ping,et al. The clinical value of monitoring plasma D?蛳 dimer concentrations in treating acute iliofemoral deep venous thrombosis[J].journal interventional radiology,2013,(06):464.
[2]陈旭姣,丁长伟,畅智慧,等.原发性肝癌患者肝动脉化疗栓塞术治疗前、后血浆D- 二聚体变化的临床意义 [J].介入放射学杂志,2017,(12):1128.
 CHEN Xujiao,DING Changwei,CHANG Zhihui,et al.Clinical significance of the changes in plasma D- dimer levels in HCC patients after receiving TACE[J].journal interventional radiology,2017,(06):1128.
[3]刘 强,程英升,王永利.D- 二聚体及纤维蛋白原监测在导管接触溶栓治疗急性下肢深静脉血栓形成中的应用 [J].介入放射学杂志,2018,27(11):1031.
 LIU Qiang,CHENG Yingsheng,WANG Yongli..The application of monitoring of plasma D- dimer and fibrinogen concentrations in treating acute lower extremity deep venous thrombosis with catheter- directed thrombolysis[J].journal interventional radiology,2018,27(06):1031.
[4]刘 强,王永利,王征宇,等.导管接触溶栓治疗急性下肢深静脉血栓形成时D-二聚体和纤维蛋白原变化规律 [J].介入放射学杂志,2019,28(05):421.
 LIU Qiang,WANG Yongli,WANG Zhengyu,et al.Study on the changes of plasma D- dimmer and fibrinogen concentrations in catheter- directed thrombolysis for acute lower extremity deep venous thrombosis[J].journal interventional radiology,2019,28(06):421.

备注/Memo

备注/Memo:
(收稿日期:2020-08-21)
(本文编辑:边 佶)
更新日期/Last Update: 2021-06-25