年龄校正D-二聚体对住院患者肺栓塞的诊断价值
发布时间：2018-10-23 10:24
【摘要】：目的:通过比较疑诊肺血栓栓塞症(PTE)的住院患者简易Wells评分联合传统D-二聚体(CDD)或年龄校正的D-二聚体(AADD)对PTE的诊断价值,探讨AADD在住院患者PTE诊断中的临床意义。方法:研究对象为2013年1月至2016年12月在山西医科大学第一医院呼吸与危重症医学科住院的疑似PTE患者。首先根据临床资料对患者行简易Wells评分,将患者分为PTE不可能组(Wells评分2分)和PTE可能组(Wells评分≥2分),同时收集所有患者入院首次血浆D-二聚体检测数据。以螺旋CT肺动脉造影和/或肺通气/血流灌注扫描为PTE的确诊方法。CDD临界值为500ug/L,AADD临界值为(患者年龄×10)ug/L,分别计算两组中CDD和AADD的灵敏度、特异度、阳性预测值、阴性预测值、正确率、Youden指数,并比较CDD和AADD的诊断价值。结果:PTE不可能组:CDD的灵敏度、特异度、阳性预测值、阴性预测值、正确率、Youden指数分别为96.77%、56.98%、76.43%、92.45%、80.48%、0.5373,AADD的灵敏度、特异度、阳性预测值、阴性预测值、正确率、Youden指数分别为96.77%、73.26%、83.92%、94.03%、87.14%、0.7003。CDD与AADD诊断的灵敏度、阴性预测值均达90%以上,两者的排除效能均高;CDD诊断的特异度较低,经年龄校正后较CDD有一定程度的提高,两者比较差异有统计学意义(P0.05);AADD的阳性预测值较CDD增加了7.49%,但两者差异无统计学意义(P㧐0.05);AADD的正确率、Youden指数均较CDD升高,两者比较差异有统计学意义(P0.05)。PTE可能组:CDD的灵敏度、特异度、阳性预测值、阴性预测值、正确率、Youden指数分别为98.11%、58.33%、93.98%、82.35%、92.90%、0.5644,AADD的灵敏度、特异度、阳性预测值、阴性预测值、正确率、Youden指数分别为97.48%、62.50%、94.51%、78.95%、92.90%、0.5998。AADD诊断的阴性预测值未达80%,CDD的阴性预测值较AADD稍高,二者的排除价值均不是很高;AADD的特异度、Youden指数较CDD稍有升高,但差异无统计学意义(P㧐0.05);AADD与CDD的阳性预测值、灵敏度、正确率均高达90%以上,但两者比较差异均无统计学意义(P㧐0.05)。结论:1.简易Wells评分2分联合D-二聚体阴性对疑诊PTE患者具有较高的排除诊断价值,适合排除临床可能性低的疑诊PTE住院患者,且AADD的排除效能较CDD进一步提高。2.对于简易Wells评分≥2分的PTE可能患者,联合CDD或AADD的排除价值不大。因此,临床上对评分高度怀疑PTE的患者应尽早行确诊检查。3.简易Wells评分≥2分联合CDD或AADD的阳性预测值较高,对PTE的诊断有一定的提示作用。4.简易Wells评分是对疑诊PTE患者的患病可能性进行初步评估,在基层医院有其应用价值,但不适合用于有PTE诊断经验的三甲医院呼吸科。
[Abstract]:Objective: to compare the diagnostic value of simple Wells score of suspected pulmonary thromboembolism (PTE) patients with conventional D-dimer (CDD) or age-corrected D-dimer (AADD) in the diagnosis of PTE, and to explore the clinical significance of AADD in PTE diagnosis of hospitalized patients. Methods: the subjects were suspected PTE patients hospitalized in the Department of Respiratory and critical Care Medicine, first Hospital of Shanxi Medical University from January 2013 to December 2016. The patients were divided into PTE impossible group (Wells score 2 points) and PTE possible group (Wells score 鈮，
本文编号：2288956
[Abstract]:Objective: to compare the diagnostic value of simple Wells score of suspected pulmonary thromboembolism (PTE) patients with conventional D-dimer (CDD) or age-corrected D-dimer (AADD) in the diagnosis of PTE, and to explore the clinical significance of AADD in PTE diagnosis of hospitalized patients. Methods: the subjects were suspected PTE patients hospitalized in the Department of Respiratory and critical Care Medicine, first Hospital of Shanxi Medical University from January 2013 to December 2016. The patients were divided into PTE impossible group (Wells score 2 points) and PTE possible group (Wells score 鈮，
本文编号：2288956
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