肺灌注显像结合Wells评分及D-二聚体检查对急性肺血栓栓塞症的诊断价值

Pulmonary perfusion imaging combined with Wells score and D-dimer assay for the diagnosis of acute pulmonary embolism

目的评价肺灌注显像结合Wells评分及D-二聚体检查对急性肺血栓栓塞症（APE）的诊断价值。方法选择2006年1月至2008年12月连续121例疑诊APE的初诊患者，所有患者均进行Wells评分、D-二聚体检查、胸部X线检查及核素肺灌注显像。分别计算肺灌注显像结合x线胸片（Q／X显像）、Q／X显像结合Wells评分或（和）D-二聚体检查用于诊断APE的灵敏度、特异性、阳性预测值和阴性预测值。结果全部121例患者中，41．3％（50／121）的患者最终诊断为APE；58．7％（71／121）最终排除了APE。Q／X显像示APE阳性者49例（40．5％）。Q／X显像的诊断灵敏度、特异性、阳性预测值、阴性预测值分别为86．O％（43／50）、91．5％（65／71）、87．8％（43／49）和90．3％（65／72）。Q／x显像对于Wells评分〉4且D-二聚体阳性（≥0．5mg／L）的患者，其APE阳性预测值为100．0％（29／29）；Q／X显像对Wells评分≤4且D-二聚体阴性（〈0．5mg／L）的患者，其APE阴性预测值亦为100．0％（41／41）。结论Q／X显像结合Wells评分及D-二聚体检查可以有效提高Q／X显像诊断APE的阳性预测值和阴性预测值，从而更准确地诊断APE。

Objective To investigate the value of the Wells score and D-dimer assay in assisting pulmonary perfusion imaging （PPI） for the diagnosis of acute pulmonary embolism （APE）. Methods One hundred twenty-one patients with suspected APE were studied from January, 2006 to December, 2008. All patients underwent the Wells score, the quantitative D-dimer assay, chest X-ray photography, and PPI. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of PPI with the assistance of Wells score and D-dimer assay were calculated. Results Fifty （41.3%） patients were diagnosed with APE. PPI combined with chest X-ray photography （ Q/X scan） showed positive results in 49 patients. The sensitivity, specificity, positive predictive value and negative predictive value of the Q/X scan were 86.0% （43/50）, 91.5% （65/71）, 87.8% （43/49） and 90.3% （65/72）, respectively. With assistance of Wells score 〉4 and D-dimer≥0.5 mg/L, Q/X scan had a positive predictive value of 100.0% （29/29）, for patients with Wells score≤4 and D-dimer 〈0.5 mg/L, the negative predictive value for Q/X scan was 100.0% （41/41）. Conclusion Combined with Wells score and D-dimer assay, PPI can make accurate diagnosis of APE.