三种量表在心内科对肺栓塞预测价值的比较

摘要

目的 比较3种肺栓塞(PE)临床评估量表对心内科疑诊PE的预测价值.方法 对2010年1～10月于我院心内科住院时疑诊PE的患者同时行Wells、Geneva和改良Geneva量表评分,并行64层CT肺动脉造影(CTPA).通过受试者工作特征(ROC)曲线下面积比较3种临床评估量表对PE的预测价值.结果 175例患者中,CTPA诊断PE的患者33例(18.9％).PE患者的Wells、Geneva量表评分均高于非PE者,差异有统计学意义(P＜0.05),而改良Geneva量表评分在两组间差异无统计学意义(P＞0.05).Wells量表评分显示PE低、中、高度可能性患者中,PE患者分别占9.3％(10/108)、32.3％(21/65)和100％(2/2)；Geneva量表评分显示,PE患者分别占15.8％(21/133)、23.1％(9/39)和100％(3/3)；而改良Geneva量表评分显示,PE患者分别占14.8％(16/108)、24.2％ (16/66)和100％(1/1).Wells、Geneva和改良Geneva量表评分对PE的预测的ROC曲线下面积分别为:0.77 ±0.06、0.63±0.06和0.61 ±0.05.其中Wells量表评分的ROC曲线下面积最大,差异有统计学意义(P＜0.05).结论 在心内科,3种量表评分中,Wells量表评分对PE的预测价值较高,可作为PE的临床基本筛查方法.%Objective To compare the clinical value of three pre-probability scores in prediction of pulmonary embolism (PE) admitted to the department of cardiology. Methods One hundred and seventy five consecutive patients with suspected PE underwent prospective CT pulmonary angiography ( CTPA) at the time of initial diagnosis. Three clinical predication scoring systems (Wells', Geneva' and revised Geneva') were used to evaluate the probability of PE in these patients. The predictive accuracy of three scores was compared by area under the curve ( AUC ) of receiver operating characteristic ( ROC ) curves. Results The overall prevalence of PE was 18. 9% (n = 33) for the patients with suspected PE in the department of cardiology. The Wells score and Geneva score of the patients with PE were higher than that of the patients without PE (P < 0. 05). The revised Geneva score of the patients with PE was the same as that of the patients without PE ( P > 0. 05). Prevalence of PE in the low, moderate and high pretest probability groups was 9. 3% , 32. 3% and 100% by Wells score, 15. 8% , 23. 1% and 100% by Geneva score, and 14. 8% , 24.2% and 100% by revised Geneva score, respectively. The Wells score performed better than the both Geneva score and revised Geneva score in patients with a low or moderate suspicion of PE ( P < 0. 05). The AUC for the Wells score, Geneva score and the simplified revised Geneva score was 0. 77 ± 0. 06, 0. 63 ± 0. 06 and 0. 61 ± 0. 05 respectively. The AUC for the Wells score was larger than the other two pre-probability scores ( P < 0. 05 ). Conclusions In department of cardiology, the Wells score appears to be more accurate than the Geneva score and revised Geneva score and can be used as basic method in screening PE.