Wells评分和修改的Geneva评分对急性肺栓塞的预测价值

The diagnostic values of Wells score and modified Geneva score for pretesting acute pulmonary embolism： a prospective study

目的评价Wells评分和修改的Geneva评分对急性肺栓塞诊断的预测效能，以期选择适合我国肺栓塞诊断的最佳评分方法。方法连续纳入首都医科大学附属复兴医院2009年6月至2011年8月所有临床疑诊肺栓塞并接受经CT肺动脉造影（CTPA）检查的患者。在患者进行CTPA检查前或同时在不知检查结果的前提下，临床医师用Wells评分和修改的Geneva评分对患者进行临床评分，以预测其发生肺栓塞的可能性。应用ROC曲线比较两种评分方法对急性肺栓塞诊断的预测价值。结果共人选139例患者，剔出无效病例22例，有效病例117例，其中经CTPA确诊为急性肺栓塞者47例，肺栓塞的确诊率为40．2％。Well评分为低度、中度、高度疑似者中肺栓塞的确诊率为7．1％（3／42）、42．9％（21／49）、88．5％（23／26）。修改的Geneva评分为低度、中度、高度疑似者中肺栓塞的确诊率为10．O％（3／30）、48．1％（37／77）、7／10。Wells评分和修改的Geneva评分的AUC。分别为0．872（95％C10．810-0．933）、0．734（95％C10．643-0．825），差异有统计学意义（P=0．005）。结论对急性肺栓塞诊断的临床预测效能Wells评分优于修改的Geneva评分。

Objective To assess the diagnostic predictive value of Wells score and modified Geneva score for acute pulmonary embolism by prospective case series and to explore a more suitable scoring system for Chinese population. Methods All the patients suspected of pulmonary embolism （PE） and received CT pulmonary angiography （CTPA） were enrolled consecutively in Fuxing Hospital, Capital Medical University, China, from June 2009 to August 2011. Before CTPA test or on condition that test results were unknown, clinical scoring was assessed prospectively by the Wells score and the modified Geneva score. The probability of PE in each patient was assessed and the patients were divided into low, moderate and high probability groups according to the clinical scores. The result of CTPA was used as the diagnostic gold standard for PE. Diagnostic accuracy in each group was analyzed. The predictive accuracy of both scores was compared by AUCRoc curve. Results A total of 139 patients met our enrollment criteria and 117 eligible patients entered our study at last. PE was diagnosed in 47 patients by CTPA with an overall prevalence of 40. 2%. Prevalence of PE in the low, moderate and high pretest probability groups assessed by the Wells score and by the simplified modified Geneva score were 7. 1% （3/42）, 42. 9% （21/49）, 88.5% （23/26） and 10. 0% （ 3/30）, 48.1% （ 37/77 ）, 7/10, respectively. AUCRoc curves for the Wells score and the simplified modified Geneva score were O. 872 （95% CI O. 810-0. 933 ） and 0. 734 （ 95% CI O. 643-0. 825 ） respectively, with a significant difference （P = 0. 005）. Conclusion The Wells score is more accurate for clinical predicting acute PE than the modified Geneva score.