Wells评分对临床诊断肺栓塞的应用价值

Application value of clinical diagnosis of pulmonary embolism by using Wells scoring standards

目的将Wells简易评分标准应用于临床肺栓塞诊断,以提高肺栓塞诊断率,降低肺栓塞的误诊率及死亡率。方法回顾性分析282例可疑肺栓塞患者的临床表现、实验室检查、下肢血管彩色超声、核素肺通气-灌注扫描、螺旋CT肺动脉造影(CTPA)及心脏超声等临床资料,应用Wells评分标准对282例疑似肺栓塞患者进行评分。结果肺栓塞可能135例(47.8%),肺栓塞不可能147例(52.2%)。以肺栓塞金标准诊断方法进行诊断,肺栓塞可能中确诊有86例(87.8%),肺栓塞不可能中确诊有12例(12.2%);诊断肺栓塞的灵敏度和特异度分别为88.8%和73.4%。ROC曲线下面积为0.854。结论 Wells评分是一项有较高灵敏度和特异性的临床诊断肺栓塞的评分体系,有较高的临床应用价值。

Objective To improve the diagnosis rate and reduce the mortality rate in pulmonary embolism pulmonary by Wells simple scoring standards.Methods Clinical data of 282 cases with suspected pulmonary embolism,such as clinical manifestation,laboratory examination,blood vessels of lower limbs with color Doppler ultrasound,Radionuclide ventilation-perfusion scans in lung,computed tomography pulmonary angiogram（CTPA）and echocardiogram were scored by Wells scoring standards in a retrospective analysis.Results There were 135 cases（47.8%）which had the possibility of pulmonary embolism,while 147 cases（52.2%）were not pulmonary embolism.With the gold standards in the diagnosis methods of pulmonary embolism,pulmonary embolism may be diagnosed in 86 cases（87.8%）,and pulmonary embolism may be excluded in 12 cases（12.2%）;The sensitivity and specificity degrees of pulmonary embolism diagnosis were respectively 88.8% and 73.4%.The area under the ROC curves was 0.854.Conclusion Wells score is higher sensitivity and specificity for clinical diagnosis of pulmonary embolism.