Wells评分、Kahn评分、St. André评分、Constans评分对下肢深静脉血栓的诊断价值研究

Scores of Wells,Kahn,St. André,Constans:Diagnostic Values in Deep Venous Thromboembolism

目的评价Wells评分、Kahn评分、St.André评分、Constans评分对下肢深静脉血栓(DVT)的诊断价值。方法选择2006年7月—2009年3月在宁夏医科大学总医院行直接CT静脉造影(CTV)、间接CTV、下肢B超检查的疑诊DVT的住院患者278例,分别行下肢Wells评分、Kahn评分、St.André评分、Constans评分。以各评分低度可能DVT作为阴性结果,中度可能DVT和高度可能DVT作为阳性结果;以CTV检查和/或下肢B超作为诊断DVT的金标准,分别计算各评分诊断DVT的灵敏度、特异度、阳性预测值、阴性预测值和ROC曲线下面积(AUC)。结果各评分诊断DVT的灵敏度、特异度、阳性预测值、阴性预测值、AUC,Wells评分为92.3%、48.9%、65.7%、85.7%、0.845;Kahn评分为64.3%、29.6%、49.2%、44.0%、0.526;St.André评分为90.2%、51.8%、66.5%、83.3%、0.761;Constans评分为95.8%、23.0%、56.8%、83.8%、0.755。Z检验结果显示,除St.André评分与Constans评分诊断DVT的AUC差异无统计学意义外,其他评分两两比较,差异均有统计学意义(P<0.05)。结论通过比较Wells评分、Kahn评分、St.André评分、Constans评分对DVT的诊断价值发现,Wells评分在4种评分中诊断效能最高,比较适用于中国人群。

Objective To evaluate the values of the scores of Wells,Kahn,St. Andre,Constans in diagnosis of deep venous thromboembolism（ DVT）. Methods A total of 278 suspected DVT patients hospitalized in General Hospital of Ningxia Medical University from July 2006 to March 2009 underwent scores of Wells,Kahn,St. Andr＆#233;,Constans,respectively. We take low possibility of DVT of each score as negative result,middle and high possibility of DVT as positive result,and CT venog-raphy（ CTV）and（ or）ultrasonography as gold standard. The sensitivity,specificity,positive predictive value,negative pre-dictive value and ROC area under curve（ AUC） of the scores in DVT diagnosis were calculated. ResUlts The sensitivity,spe-cificity,positive predictive value and negative predictive value,ROC AUC of Wells Score in DVT diagnosis were 92. 3%, 48. 9%,65. 7%,85. 7%,0. 845,respectively;those of Kahn Score were 64. 3%,29. 6%,49. 2%,44. 0%,0. 526,re-spectively;those of St. Andre Score were 90. 2%,51. 8%,66. 5%,83. 3%,0. 761,respectively;those of Constans Score were 95. 8%,23. 0%,56. 8%,83. 8%,0. 755,respectively. By Z test,there was no significant differences in DVT diagno-sis in scores of St. Andre; and Constans,and there was difference between any other 2 scores（P〈0. 05）. ConclUsion Com-parison of DVT diagnosis in scores of Wells,Kahn,St. Andre,Constans has found that the diagnostic efficiency of Wells score is the highest,which is more suitable for Chinese people.