摘要
目的探讨Geneva量表结合血浆D-二聚体测定对肺栓塞的早期诊断价值。方法回顾性分析1995年1月至2007年11月在上海市肺科医院住院的658例疑似肺栓塞患者的临床资料。采用Geneva量表计算所有疑似肺栓塞患者的评分，按得分划分为低度（0～4分）、中度（5～8分）和高度（≥9分）可疑。分别以Geneva量表、D-二聚体测定以及两者结合3种方法来对肺栓塞做初步诊断，并与最终影像学检查确诊的诊断结果进行分析比较。结果共有267例患者确诊为肺栓塞。Geneva量表和血浆D-二聚体测定诊断肺栓塞的灵敏度分别为88．4％和90．3％、阴性预测值分别为88．9％和90．2％，Youden指数分别为0．52和0．51；两者结合诊断肺栓塞的敏感度、阴性预测值和Youden指数分别为97．8％、97．3％和0．54；两试验均为阳性的似然比为2．62，均为阴性的似然比为0．04。结论Geneva量表和血浆D-二聚体测定简单易行，对肺栓塞早期筛选具有价值，有利于节省不必要的医疗开支。两种方法结合有互补作用，可以提高诊断的准确性，降低漏诊率。
Objective To study the value of Geneva score assessment combined with simplified rapid plasma D-dimer assay （SRPDDA） for early diagnosis of pulmonary embolism （PE）. Methods Clinical data of 658 suspected cases of PE hospitalized at Shanghai Pulmonary Hospital during January 1, 1995 to November 30, 2007 were retrospectively analyzed. The patients were divided into three categories based on their Geneva score assessment, highly suspected with equal to or greater than 9 scores, intermediately suspected with 5 -8 scores and mildly suspected with equal to or less than 4 scores, respectively. Clinical diagnosis for PE of the patients was made based on their probability Geneva score developed by Wicki, SRPDDA, and both Geneva score assessment and SRPDDA, respectively, and compared with results of lung imaging. Results Finally, PE diagnosis was established in 267 cases. Sensitivity for Geneva score and SRPDDA to diagnose PE was 88.4% and 90. 3%, with negative predictive value （NPV） of 88.9% and 90. 2% and Youden Index （YI） of 51.7% and 51.4%, respectively. And, sensitivity of both Geneva score assessment combined with SRPDDA was 97.8% , with NPV and YI of 97. 3% and 53.8% , respectively, with a likelihood ratio （LR） for both positive test results of 2. 62 and a LR for both negative test results of 0. 04, respectively. Conclusions As a routine and non-invasive diagnostic test, Geneva score assessment, as well as SRPDDA, play a screening role in early diagnosis for PE, which can help to save unnecessary cost of imaging, and complement each other so to improve accuracy of diagnosis and reduce misdiagnosis.
出处
《中华全科医师杂志》
2008年第12期822-824,共3页
Chinese Journal of General Practitioners
关键词
肺栓塞
诊断
临床评估量表
D-二聚体
Pulmonary embolism
Diagnosis
Clinical assessment
D-dimer
