修正Geneva量表及D-二聚体对慢性阻塞性肺疾病急性加重合并肺血栓栓塞症的预测价值

Evaluation of Geneva score combined with D-dimmer assay in diagnosis of acute exacerbation of chronic obstructive pulmonary disease with pulmonary thromboembolism

目的评价修正Geneva量表结合D-二聚体在诊断慢性阻塞性肺疾病急性加重期(AECOPD)合并肺血栓栓塞症(PTE)中的诊断价值。方法收集2011年1月至2013年5月于我院急诊及住院的AECOPD疑似合并PTE的210例患者进行前瞻性研究,对患者临床资料,并分别以修正Geneva量表、D-二聚体测定以及两者结合评估合并肺栓塞的可能性,并与最终确诊的诊断结果进行分析比较。结果其中41例患者确诊PTE。AECOPD+PTE组与单纯AECOPD组在症状、体征上仅不对称下肢水肿有统计学差异。D-二聚体<500μg/L的阴性预测值为96.1%,而阳性预测值仅34.3%,特异度58.0%灵敏度90.2%。修正Geneva量表可能性高组阳性预测值为64.0%,可能性低组阴性预测值为94.7%;两者结合的阳性预测率为42.5%,阴性预测值96.9%。结论修正Geneva量表和血浆D-二聚体测对慢性阻塞性肺疾病急性加重期合并肺栓塞早期筛选具有价值,两种方法结合可以提高诊断的准确性,降低漏诊率。

Objective To study the value of the Revised-Geneva score combined with plasma D- dimmer assay for predicting the probability of the acute exacerbation of chronic obstructive pulmonary disease （AECOPD） patients complicated with pulmonary thromboembolism （PTE）. Methods 210 cases of AECOPD suspected with PTE were collected from January 2010 to May 2013. Relevant clinical data were recorded. Revised-Geneva score and plasma D-dimmer assay, respectively and combined, were used to evaluate the probability of PTE. Result 41 cases were diagnosed as PTE. In the AECOPD with PTE group, only the incidence of asymmetric swelling of lower limbs was obviously higher than that of AECOPD group. Standard threshold （ 〈 500μg/L）, D-dimmer was negative in 98/102 （negative predictive value 96.1% ）, and 37/105 were PTE ＋ （posterior predictive value 34. 3% ）. And the positive predictive valve was 64. 0% in high probability presents （ Revised- Geneva score≥ 11 points）, while the negative predictive value was 94.7 % （ score ≤3）. The positive predictive value of the combination was 42. 5%, while negative predictive value was 96.9%. Conclusions As a routine and non-invasive diagnostic test, the Revised-Geneva score assessment, as well as plasma D-dimmer assay, play a screening role in early diagnosis for the acute exacerbation of chronic obstructive pulmonary disease （AECOPD） patients complicated with PTE. And complement each other can improve accuracy.