D-二聚体和Wells评分在主动脉夹层和急性肺栓塞鉴别诊断中的应用

发布时间：2018-03-30 12:01

本文选题：肺栓塞　切入点：主动脉夹层　出处：《中国老年学杂志》2017年03期

【摘要】：目的探讨D-二聚体和Wells评分在主动脉夹层和急性肺栓塞鉴别诊断中的应用。方法回顾性分析行胸痛二联CT血管造影术(CTA)检查的住院患者的一般资料、D-二聚体、Wells评分量表,探讨Wells评分联合D-二聚体对鉴别诊断急性肺栓塞和主动脉夹层的预测价值。结果行胸痛二联CTA检查的全部患者中,确诊为肺动脉栓塞者56例,确诊率为25%;确诊为主动脉夹层患者72例,确诊率为33%;余92例未见明显异常,占42%。Wells评分、D-二聚体及二者联合预测肺栓塞时,曲线下面积分别是0.859(95%CI:0.803~0.915),0.783(95%CI:0.723~0.843),0.924(95%CI:0.885~0.963),联合预测肺栓塞时曲线下面积明显增大。Wells评分与D-二聚体联合预测肺动脉栓塞的最佳截点为Wells评分2分,主动脉夹层1 650.00μg/L,敏感性94.6%,特异性78.0%。而当D-二聚体升高并低于1 650μg/L时,主动脉夹层组中Wells评分≤1分的患者比例明显高于肺栓塞及正常对照组。结论 D-二聚体对主动脉夹层或肺栓塞的临床预测敏感性较高,但特异性较差;Wells评分对肺栓塞的临床预测敏感性低,特异性较高。Wells评分联合D-二聚体对肺栓塞、主动脉夹层的临床预测有明确意义:当Wells评分≥2分、D-二聚体≥1 650μg/L时,临床上更倾向肺栓塞的可能;当Wells评分≤1分、D-二聚体升高(≥500μg/L)并1 650μg/L时,临床上更倾向主动脉夹层的可能。
[Abstract]:Objective to investigate the application of D- two dimer and Wells score in the diagnosis of aortic dissection and acute pulmonary embolism. Methods a retrospective analysis of two chest CT angiography (CTA) examination of the general data of hospitalized patients with D-, two dimers, Wells scale, to explore the combination of two D- dimer to prediction value identification the diagnosis of acute pulmonary embolism and aortic dissection. Results the Wells scores of all patients underwent chest pain two CTA examination in the diagnosis of pulmonary artery embolism in 56 cases, the diagnosis rate was 25%; 72 cases were diagnosed with aortic dissection, the diagnosis rate was 33%; 92 cases had no obvious abnormalities, 42%.Wells score, D- two the dimer and the two combined prediction of pulmonary embolism, the area under the curve was 0.859 (95%CI:0.803~0.915), 0.783 (95%CI:0.723~0.843), 0.924 (95%CI:0.885~0.963), the combined prediction of pulmonary embolism under curve area increased significantly with the.Wells score two D- dimer combined pre The best cut-off point of measurement of pulmonary embolism Wells score 2, aortic dissection 1650 g/L, sensitivity 94.6%, specificity 78.0%. when D- two dimer increased and less than 1650 g/L, Wells group of aortic dissection in 1 or less were the proportion of patients with pulmonary embolism and was significantly higher than that of normal control group. Conclusion D- two the dimer is sensitive to the clinical prediction of aortic dissection or pulmonary embolism, but the specificity is low; the Wells scores of clinical prediction of pulmonary embolism with low sensitivity, high specificity.Wells score combined with two D- dimer in pulmonary embolism, there is a clear significance of clinical predictors of aortic dissection: when Wells score more than 2 points, D- two poly the body of more than 1650 g/L, clinical pulmonary embolism may be more likely; when the Wells score less than 1 points, two D- dimer increased (more than 500 g/L and 1650 g/L), the clinical tend of aortic dissection.

【作者单位】：吉林大学第一医院;
【分类号】：R563.5

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