年龄校正的D-二聚体联合Wells评分在老年急性肺栓塞中的诊断价值

Diagnostic Value of Age-adjusted D-dimercombined with Wells Score for Suspected Acute Pulmonary Embolism in the Elderly

目的:评价年龄校正的D-二聚体联合Wells评分对老年急性肺栓塞(APE)的诊断价值。方法:回顾性分析2015年2月-2019年6月在笔者所在医院呼吸科收治的疑似老年APE患者210例,所有患者在住院期间均检测D-二聚体和行CT肺动脉造影(CTPA),计算出年龄校正的D-二聚体值(年龄×10 μg/L),并进行Wells二分类法评分,以CTPA为确诊金标准,分析比较年龄校正的D-二聚体、Wells评分及两者联合对老年APE的诊断价值。结果:82例患者经CTPA确诊为APE,年龄校正的D-二聚体和Wells评分诊断APE的敏感性分别为95.12%和90.24%、特异性为48.44%和46.88%、阳性预测值(PPV)为54.17%和52.11%、阴性预测值(NPV)为93.94%和88.24%,约登指数分别为0.44和0.37。两者联合诊断APE的敏感性、特异性、PPV、NPV和、分别为87.80%、67.19%、PPV 63.16%、89.58%和0.55。与年龄校正的D-二聚体或Wells评分相比,两者联合诊断APE的特异性显著较高(P<0.01),而未降低敏感性、阳性预测值和阴性预测值(P>0.05)。结论:年龄校正的D-二聚体联合Wells评分能提高诊断老年APE的特异性而不降低敏感性、阳性预测值和阴性预测值,对老年APE的诊断价值较高,有较高的临床应用价值。

Objective:To evaluate the value of age-adjusted D-dimer combined with Wells score for suspected acute pulmonary embolism (APE) in the elderly.Method:In this retrospective study,210 patients with suspected APE were enrolled between February 2015 and June 2019.D-dimer tests and computed tomographic pulmonary angiography (CTPA) were performed.Taking CTPA as golden standard,the diagnostic value of age-adjusted D-dimer (age×10 μg/L),Wells score and the combination of the two was analysed respectively.Result:A total of 82 cases were confirmed by CTPA.The sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) and Youden index in the diagnosing APE of age-adjusted D-dimer and Wells score were 95.12% and 90.24%,48.44% and 46.88%,54.17% and 52.11%,93.94% and 88.24%,0.44 and 0.37,respectively.The sensitivity,specificity,PPV,NPV and Youden index of the combination of the above two were 87.80%,67.19%,63.16%,89.58% and 0.55,respectively.Alone compared with age-adjusted D-dimer or Wells score,the specificity of the combination of the two in the diagnosis of APE was significantly higher (P<0.01),and its sensitivity,PPV or NPV were not decreased (P>0.05).Conclusion:The combination of age-adjusted D-dimer and Wells score improves the diagnostic specificity of APE,and which has relatively high value in diagnosing APE and high clinical application value.