疑诊肺栓塞患者患病风险评估的新模型

A New Risk Assessment Model for Suspected Pulmonary Embolism

目的建立新的肺栓塞(PE)患病风险评估模型,提高肺动脉CTA的阳性检出率。方法将研究样本中PE患病组和非患病组组间有统计学差异的变量纳入logistic回归分析,构建疑诊PE的患病风险评估模型。根据模型求得的每位患者的患病概率,绘制受试者工作(ROC)曲线并确定截断值。另收集验证样本评价该模型的诊断效能。结果对研究样本的单因素分析显示,共17个变量在患病和非患病2组间存在统计学差异。其中不明原因的呼吸困难、整条腿肿胀/凹陷性水肿、D-二聚体和年龄是患PE的独立危险因素。由ROC曲线确立模型的截断值为0.38。验证样本显示,本研究提出的PE患病风险评估模型可将我院肺动脉CTA阳性检出率从27%提高至54%。结论新的PE患病风险评估模型可提高肺动脉CTA的检出率。

Objective To develop a predictive model for pulmonary embolism（PE）based on the related clinical symptoms,signs,and the laboratory index,so as to improve the positive rate of CTPA. Methods The model was developed from a database of 119 patients with suspected PE.The risk factors of suspected PE were analyzed by logistic regression analysis,which included significant differences in the prevalence of PE between non-diseased and non-diseased groups. Receiver operating characteristic（ROC）curves was draw to determine the cut-off value of the clinical probability. It was validated in an independent sample of 106 patients with suspected PE. Results According to the univariate analysis,17 of51 variables show a significant difference between PE and non-PE patients. The model comprised 4 variables：age,dyspnea,D-dimer and unilateral leg swelling. The area under the ROC curve is 0.776,and the cut-off value is supposed to be 0.38. In the validation sample,27% patients had PE confirmed by CTPA. The prevalence of PE was 54% when the clinical probability was above 0.38. Conclusion The proposed predictive model in this study can improve the positive rate of CTPA,simplify the diagnosis process of suspected PE patients.