修正的Geneva评分对肺栓塞相关的慢性阻塞性肺疾病的临床预测价值

Clinical prediction value of revised Geneva scores for PE-COPD

目的了解肺栓塞相关的慢性阻塞性肺疾病（PE—c0PD）的患病率和发病特点，重点探讨Gevena评分预测PECOPD的临床价值。方法回顾性地分析天津医科大学总医院2009年2月至2011年12月诊治的急性肺栓塞患者的临床资料，并对每例PE—COPD患者进行Geneva评分，应用受试者工作特征（ROC）曲线评价Geneva评分对PE—COPD的预测价值，同时分析该评分与肺功能、血气指标的相关性。结果127例急性肺栓塞患者中，基础疾病为COPD的患者16例，患病率为12．6％（95％CI6．8％～18．4％）；Geneva评分用于预测PE—COPD的R0c曲线下面积（AUC）为0．759（P〈0．05），95％a为0．654～0．873，最佳临界值为5．5，≥5．5灵敏度和特异度分别为81．3％和63．1％，且患者的FEV。％pred、PaO2与Geneva分数呈负相关（P〈o．05），FEV1／FVC％、pH、PaCO。与Geneva分数无相关性（P〉O．05）。结论Geneva评分对PE—COPD有一定的预测价值，尤其是肺功能较差、严重低氧血症的COPD患者，有较高发生肺栓塞的临床概率。

Objective To understand the prevalence and clinical characteristic of chronic obstructive pulmonary disease associatied with pulmonary embolism （PE-COPD）, analyze the predictive value of Geneva scores for it and correlation between Geneva scores and lung function scale as well as scale of blood gas analysis. Methods Retrospectively survey for in patient medical database of PE patients who were discharged from Tianjin Medical University Genenral Hospital from February, 2009 to December, 2011. Each PE-COPD patient w/is applied Geneva scores, and receiver operating characteristic （ROC） carve was used to evaiute its clinical value for PE-COPD. Results Of 127 patients with a conformed diagnosis of acute PE,the amount of PECOPD patients were 16 （17.6%,95% CI 6.8% 18.4%）. The area under curve （AUC） of the ROC curve in Geneva scores predicted PE COPD was 0. 759（ P d0.05）, 95 % confidence interval （ CI ） was 0. 654-0. 873. The optimal cutoff value was 5.5, the score more than 5.5 with a sensitivity of 81.3% and specificity of 63.1%, then FEV1 % pred and PaO2 of PE-COPD patients were negtively correlated with Geneva scores （ P 〈0. 05） ,but FEV1/FVC% and PaCO2 as well as PH was no correlated with it （ P 〉0.05）. Conclusions Geneva scores being certain predictive value of PE COPD,in particular, COPD patient of poor lung function and severe hypoxemia has higher clinical probabolity of PE.