Wells量表和修正的Geneva评分对肺栓塞的预测价值分析

Predictive Value of Pulmonary Embolism in Wells Scale and Revised Geneva Score

目的:分析Wells量表和修正的Geneva评分对肺栓塞(PE)的预测价值。方法:选取2016年1月-2017年9月本院住院疑似肺栓塞患者240例,均采用Wells量表和修正的Geneva评分,经CT肺动脉血管造影(CTPA)确诊为肺栓塞者64例,建立受试者工作曲线(ROC)评价其对肺栓塞的预测价值。结果:Wells评分低度、中度、高度患者对PE预测符合率分别为3.70%(2/54)、22.88%(27/118)、51.47%(35/68);修正的Geneva评分低度、中度、高度患者符合率分别为3.95%(3/76)、22.61%(26/115)、71.43%(35/49)。修正的Geneva评分高度符合率高于Wells评分(χ~2=4.720,P=0.003),但两种评估量表低度、中度符合率比较,差异均无统计学意义(P>0.05)。Wells评分AUC为0.581,准确性较低,敏感度、特异度分别为0.626、0.718,预测截断值为3.52分;修正的Geneva评分AUC为0.702,准确性高于Wells评分,敏感度、特异度分别为0.753、0.732,预测截断值为7.58分。结论:Wells量表和修正的Geneva评分均对PE有一定的预测价值,修正的Geneva评分预测价值略高于Wells量表,临床上可以将两种评分方法结合使用,提高PE的早期诊断水平。

To analyze the predictive value of Wells scale and revised Geneva score for pulmonary embolism(PE).Method:There were240cases of suspected pulmonary embolism hospitalized in our hospital from January2016to September2017were selected.They were given Wells scale and revised Geneva score,and64cases of pulmonary embolism were confirmed by CT pulmonary angiography(CTPA).The receiver operating curve(ROC)was established to evaluate its predictive value for pulmonary embolism.Result:The low,moderate and high predictive coincidence rates of PE in Wells scale were3.70%(2/54),22.88%(27/118)and51.47%(35/68)respectively.The low,moderate and high predictive coincidence rates of PE in revised Geneva score were3.95%(3/76),22.61%(26/115),71.43%(35/49)respectively.The high coincidence rate in revised Geneva score was higher than that of Wells scale(χ2=4.720,P=0.003),but the low and moderate coincidence rates of the two assessment scales were compared,the differences were not statistically significant(P>0.05).The AUC of Wells scale was0.581,the accuracy was low,the sensitivity and specificity were0.626and0.718 respectively,and the predictive cut-off value was3.52point.The AUC of revised Geneva score was0.702,higher than the Wells score,the sensitivity and specificity were0.753and0.732respectively,and the predictive cut-off value was7.58point.Conclusion:Wells scale and revised Geneva score have some predictive value for PE,the predictive value of revised Geneva score is slightly higher than that of Wells scale,and the combination of the two scoring methods could improve the early diagnosis of PE.