探讨Wells评分、Geneva评分及改良Geneva评分应用于国内肺血栓栓塞症患者的诊断价值

Diagnostic accuracy of Wells, Geneva and improved Geneva Scores for predicting pulmonary embolism in Chinese patients

目的评价肺栓塞Wells评分、Geneva评分及改良Geneva评分对中国疑似肺栓塞肺血栓栓塞症（PTE）住院患者的诊断价值。方法以CT肺血管造影检查作为诊断PTE的金标准,704例疑似深静脉血栓（DVT）形成的中国住院患者分别进行肺栓塞Wells评分、Geneva评分及改良Geneva临床评分,将低可能组的患者作为PTE阴性患者,中度可能和高度可能组的患者作为PTE阳性患者,分别计算和比较每种临床评分诊断DVT的敏感性、特异性、阳性预测值、阴性预测值和ROC曲线下面积。结果肺栓塞Wells评分、Geneve评分和改良Geneve评分中,低、中和高度可能性组的PTE实际发病率为15.0%～18.0%、33.0%～48.0%和35.0%～85.%;3组敏感性、特异性、阳性预测值及阴性预测值分别为70.1%、73.1%、53.0%和84.9%,79.1%、37.0%、33.4%和81.5%,86.4%、31.0%、35.2%和84.0%;ROC曲线下面积为0.783、0.569和0.658。结论通过系统比较国外3种预测模型对疑似PTE患者的预测价值,表明肺栓塞Wells评分较适用于国人疑似PTE患者。

【Objective】 To evaluate Wells, Geneva and improved Geneva scores for the prediction of pulmonary embolism（PE） in Chinese patients. 【Methods】 The hospitalized patients, who were clinically suspected as PE and underwent CT pulmonary angiography（PA） between July 2006 and March 2009 in the Affiliated Hospital of Ningxia Medical University, were consecutively reviewed. Wells, Geneva and improved Geneva scores were evaluated in 704 Chinese patients suspected as deep vein thrombosis（DVT）. Sensitivity, specificity,positive predictive value, negative predictive value and receiver operation curves（ROC） were calculated for the three clinical scores. The area of the ROC curve for each of the scores was calculated and compared with others. 【Results】 The sensitivity, specificity, positive predictive value and negative predictive value for Wells,Geneva and improved Geneva scores were 70.1%, 73.1%, 53.0%, 84.9%; 79.1%, 37.0%, 33.4%, 81.5%;86.4%, 31.0%, 35.2%, 84.0%, respectively. The area under ROV curve for Wells, Geneva and improved Geneva scores was 0.783, 0.569 and 0.658, respectively.【Conclusion】 Based on the results of this study, the wells score is more applicable to the Chinese patients suspected of PE.