Wells量表和修正的Geneva评分对肺栓塞的预测价值

Predication of Wells and Revised Geneva Scores for Pulmonary Embolism

【目的】为减少肺栓塞误漏诊,探讨并应用受试者工作特征曲线(ROC)比较修正的Geneva和Wells评分系统对肺栓塞的预测价值。【方法】收集1998-2008年10月中山大学附属第三医院可疑肺栓塞65例,其中临床确诊肺栓塞44例,记录、归纳整理、统计分析,应用ROC曲线比较Geneva和Wells评分对肺栓塞的预测价值。【结果】Wells评分<2分肺栓塞可能性33.3%(8/24),2～6分87.2%(34/39),6分以上100%(2/2),评分增加肺栓塞可能性增大(P=0.000);Geneva评分:0～3分肺栓塞可能性22.2%(4/18);4～10分82.1%(32/39);≥11分100%(8/8)。肺栓塞可能性与Geneva评分高低有关(P=0.000)。Wells评分预测肺栓塞的ROC曲线下面积(AUC)0.785±0.060(P=0.000),最佳分界值2分,以≥2分预测肺栓塞,其敏感性81.8%,特异性76.2%;Geneva评分ROC的AUC为0.900±0.038(P=0.000),最佳分界值6.5分,以≥6.5分预测的敏感性为72.7%,特异性100%;两条曲线所对应AUC的差异有统计学意义(P<0.05)。【结论】Wells评分和Geneva评分对肺栓塞的预测均具有较好的临床价值;Geneva评分的敏感性和特异性总体上优于Wells评分。

[Objective] To reduce misdiagnosis and underdiagnosis rate of pulmonary embolism, the prediction of the revised Geneva score and Wells score for pulmonary embolism were compared and analyzed by receiver operating characteristic curves. [Methods] Sixty-five cases with suspected pulmonary embolism （PE） were collected in the Third Affiliated Hospital of SUN Yatsen University from January 1998 to October 2008. Of which 44 cases with PE were clinically confirmed. Relevant clinical data were recorded, summarized and the analysis variables were input to SPSS11.0 for statistical analysis. ROC curves was used to evaluate the probability of PE predicted by the Wells and the revised Geneva scores. [ Results ] Twenty-four patients had a low clinical probability of PE （Wells score 〈 2 points ）, of which 8 （33.3%） had proven PE. The prevalence of PE was 87.2% in the 39 patients with intermediate probability （2-6 points） and 100% in the 2 patients with high probability （〉 6 points） （P = 0.000）. The confirmed PE was 22.2% in the 18 patients with a low probability （Geneva score 0-3 points）, 82.1% （32/39） in intermediate probability （4-10 points）, 100% （8/8） in high probability （score ≥ 11 points） （P = 0.000）. The area under curve （AUC） of the ROC curve in the Wells and Geneva scores was 0.785 ± 0.060 and 0.900 ± 0.038, respectively （P = 0.000）. The optimal cutoff value was 2 points in the Wells score and 6.5 points in the Geneva score. The Wells score more than 2 points predicted PE with a sensitivity of 81.8% and specificity of 76.2% .The Geneva score more than 6 points predicted PE with a sensitivity of 72.7% and specificity of 100%. The comparison of the area under curve between the Wells and the Geneva score had a significant difference statistically （P 〈 0.05）. [Conclusion] The Wells score and the revised Geneva score are beneficial to predict pulmonary embolism. The revised Geneva score is roughly superior to the Wells score both in sensitivity and specificity.