Wells评分联合D-二聚体排除下肢深静脉血栓形成的应用价值研究

摘要

目的：评估 Wells 评分联合 D -二聚体在排除下肢深静脉血栓形成（DVT）中的应用价值。方法选取2011—2012年重庆医科大学附属永川医院收治的髋/膝关节术后疑似下肢 DVT 患者195例，根据 Wells 评分分为高风险（Wells 评分﹥1分）、低风险（Wells 评分≤1分）；D -二聚体﹥500μg/ L 为阳性；以压缩超声检查及随访确诊下肢 DVT。计算 Wells 评分联合 D -二聚体排除下肢 DVT 的灵敏度、特异度、阳性预测值、阴性预测值。结果195例患者中，压缩超声检查及随访确诊下肢 DVT 37例（19.0％），排除下肢 DVT 158例（81.0％）。195例患者中，高风险52例，其中压缩超声检查及随访确诊下肢 DVT 32例；低风险143例，其中压缩超声检查及随访确诊下肢 DVT 5例。195例患者中，D -二聚体检查阳性56例，其中压缩超声检查及随访确诊下肢 DVT 31例；D -二聚体检查阴性139例，其中压缩超声检查及随访确诊下肢 DVT 6例。Wells 评分联合 D -二聚体诊断下肢 DVT 49例（Wells 评分高风险且 D -二聚体检查阳性），其中压缩超声检查及随访确诊下肢 DVT 32例；可能为下肢 DVT 9例（Wells 评分低风险，D -二聚体检查阳性或者 Wells 评分高风险，D -二聚体检查阴性），其中压缩超声检查及随访确诊下肢 DVT 4例；排除下肢DVT 137例（Wells 评分低风险且 D -二聚体检查阴性），其中压缩超声检查及随访确诊下肢 DVT 1例。Wells 评分联合D -二聚体排除下肢 DVT 的灵敏度为97.0％、特异度为88.9％、阳性预测值为65.3％、阴性预测值为99.3％。结论Wells 评分联合 D -二聚体在排除下肢 DVT 中有很好的应用价值。%combined with D - dimer test(Wells score showed high risk and D - dimer test was positive),among whom 32 cases of DVT of lower limb were confirmed by ultrasonography and follow up;there were 9 cases of probable DVT of lower limb( Wells score showed low risk and D - dimer test was positive,or Wells score showed high risk and D - dimer test was negative),among whom 4 cases of DVT of lower limb were confirmed by ultrasonography and follow up;and 137 patients were excluded( Wells score showed low risk and D - dimer test was negative),among whom 1 case of DVT of lower limb was confirmed by ultrasonography and follow up. The sensitivity of wells score combined with D - dimer test was 97. 0% ,the specificity was 88. 9% ,positive predictive value was 65. 3% and negative predictive value was 99. 3% . Conclusion The application value of Wells score combined with D - dimer test in the removal of DVT of lower limb is good.