WELLs评分联合D-二聚体对急诊胸痛的冠心病患者发生急性肺栓塞风险的预测价值

Predictive value of WELLs score combined with D-dimer in acute pulmonary thromboembolism with coronary disease in emergency department

目的评估WELLs评分联合D-二聚体对急诊胸痛的冠状动脉粥样硬化性心脏病(简称冠心病)患者发生急性肺栓塞风险的预测价值。方法连续选取2008年3月1日至2016年1月31日以胸痛为首发症状就诊于首都医科大学附属北京安贞医院急诊科的冠心病疑诊急性肺栓塞患者226例,所有患者均行CT肺动脉造影检查,根据CT肺动脉造影结果分为冠心病合并急性肺栓塞组(98例)和单纯冠心病组(128例)。收集所有患者的临床资料及D-二聚体检测结果,并进行WELLs评分,比较单独D-二聚体、单独WELLs评分以及D-二聚体联合WELLs评分诊断冠心病合并急性肺栓塞的特异性、敏感性,制作受试者工作特征曲线(receiver operator characteristic curve,ROC曲线),应用Z检验比较ROC曲线下面积(area under curve,AUC),评价其预测价值。结果单独D-二聚体预测冠心病合并急性肺栓塞的敏感性和特异性分别为87.36%、82.42%(AUC=0.885,95%CI 0.836~0.934,Z=17.65,P<0.0001),单独WELLs评分的敏感性和特异性分别为73.68%、71.45%(AUC=0.860,95%CI 0.812~0.908,Z=10.05,P<0.0001),WELLs评分联合D-二聚体的敏感性和特异性分别为87.68%,90.14%(AUC=0.959;95%CI 0.937~0.982,Z=10.98,P<0.0001)。结论WELLs评分联合D-二聚体对急诊胸痛的冠心病患者发生急性肺栓塞风险有预测价值。

Objective The aim of this study is to explore the predictive value of WELLS score combined with D-dimer in acute pulmonary thromboembolism with coronary disease in emergency department.Method 226 chest pain patients with coronary disease undergoing CTPA admitted to the emergency department of Beijing Anzhen Hospital,Capital Medical University from March 2008 to Januray 2016.According to the different CTPA,they were grouped into 98 in the PTE with CHD group,128 in the CHD group.The clinical results of the two groups were compared.Symptoms,complications,common hematological parameters,analysis of risk factors for PTE combined with CHD,and to explore the diagnostic value of WELLS combined with D-dimer for PTE combined with CHD.All data were analyzed by SPSS 22.0 statistical software,and P<0.05 considered the difference to be statistically significant.The Logist multivariate regression analysis was performed for possible related factors.Result To predictive value of WELLS score combined with D-dimer in acute PTE with CHD in emergency department,the Sensitivity and specificity of D-dimer are 87.36%,82.42%respectively(AUC=0.885,95%CI 0.836-0.934,Z=17.65,P<0.0001);the Sensitivity and specificity of WELLs are 73.68%,71.45%respectively(AUC=0.860,95%CI 0.812-0.908,Z=10.05,P<0.0001);the Sensitivity and specificity of WELLs combined with D-dimer are 87.68%,90.14%respectively(AUC=0.959;95%CI 0.937-0.982,Z=10.98,P<0.0001).Conclusion D-dimer combined with WELLS score can improve the sensitivity and specificity of PTE combined with CHD,and the predicted value is greater than D-dimer or WELLS score alone.