三种急性肺栓塞评分预测价值比较分析

Comparison of three clinical prediction rules among inpatients with suspected pulmonary embolism.

目的回顾性分析Wells评分、Geneva评分和修改后Geneva评分对急性肺栓塞的临床可能性预测价值。方法选择2004年1月至2006年6月宁夏医学院附属医院和2005年9月至2006年10月北京朝阳医院的可疑急性肺栓塞行CT肺血管造影(CTPA)检查的患者,分别采用Wells评分、Geneva评分和修改后Geneva评分对肺栓塞疑似患者患肺栓塞的风险度进行分级,将患者分为低度可能、中度可能和高度可能3组。以CTPA结果为标准,分析各组患者的肺栓塞确诊率。结果共688例肺栓塞疑似患者入选本研究,CTPA诊断急性肺栓塞198例。所有患者均行Wells评分和修改后Geneva评分,490例行Geneva评分。低、中、高度可能组的肺栓塞确诊率为:Wells评分14.2%、53.9%、75.9%;Geneva评分17.2%、40.0%、47.1%;修改后Geneva评分17.1%、36.4%、62.9%。研究结果显示,随着预测风险的增加,各组患者的肺栓塞确诊率升高。Wells评分的ROC曲线下面积最大(0.8195),与Geneva评分(0.6869)和修改后Geneva评分(0.6895)相比,差异有统计学意义。Geneva评分和修改后Geneva评分的ROC曲线下面积差异无统计学意义。结论在对住院患者的肺栓塞临床可能性预测方面,与Geneva评分和修改后Geneva评分相比,Wells评分的价值最高。

Objective To assess the diagnostic value of clinical pretest probability prediction rules for the pulmonary embolism by retrospective case series. Methods 688 inpatients were assessed by the Wells score,the Geneva score and the revised Geneva score respectively. According to the three scales, the probability of pulmonary embolism of every patient was analyzed and the patients were divided into the low, intermediate and high probability group. The result of CT pulmonary angiography was used as the diagnostic gold standard of pulmonary embolism. Results There were 198 cases diagnosed as with pulmonary embolism by CT pulmonary angiography. All cases were performed the Wells and revised Geneva score. Because 198 cases did not have the arterial blood gas results, so 490 cases were performed the Geneva score. The prevalence of pulmonary embolism in the low probability group was Wells score 14.2% ;Geneva score 17.2% ;revised Geneva score 17. 1%. The prevalence of pulmonary embolism in the intermediate probability group was： Wells score 53.9% ;Geneva score 40. 0% ;revised Geneva score 36.4%. The prevalence of pulmonary embolism in the high probability group was：Wells score 75.9% ;Geneva score 47.1% ;revised Geneva score 62. 9%. The area under the receiver operating characteristic curve of the Wells score （0.8195 ）was the highest, and there was significant difference compared with the other two scales. Conclusion Compared with the Geneva score and the revised Geneva score,the Wells score had the highest prediction accuracy for pulmonary embolism among inpatients.