Wells评分联合校正的D-二聚体对肺癌合并急性肺栓塞的预测价值

The Predictive Value of Wells Score Combined with Adjusted D-Dimers for Lung Cancer with Acute Pulmonary Embolism

目的:探讨Wells评分联合校正的D-二聚体对肺癌合并急性肺栓塞的预测价值。方法:选取2013年11月至2020年11月在承德医学院附属医院住院的肺癌疑似APE患者130例,评价上述患者Wells评分、校正D-二聚体及两者联合时对APE的预测价值。结果:130例疑诊APE的肺癌患者中,确诊APE67例。经过Wells评分,低度可能组、中度可能组、高度可能组分别41例、72例、17例,其中确诊APE分别为14例、39例、33例,其肺癌合并APE诊断敏感度分为20.90%、58.21%、20.90%,特异性分为57.14%、47.62%、95.24%,阳性预测值分为34.15%、54.17%、82.35%,阴性预测值分为65.85%、45.83%、7.65%。校正的D-二聚体值(981ng/m L)与传统的D-二聚体值(500ng/m L)相比,诊断肺癌合并APE的特异性升高(42.86%vs23.81%,P<0.05)。Wells评分低度可能结合校正D-二聚体阴性者,其诊断肺癌合并APE的阴性预测价值可升至94.44%。130例疑似APE的肺癌患者的D-二聚体的ROC曲线,提示D-二聚体的临界值为1975ng/m L,高于传统的D二聚体临界值500ng/m L。结论:Wells评分低度可能联合校正D-二聚体阴性时有利于除外肺癌患者中的疑似APE患者,而且肺癌合并肺栓塞患者往往具有较高水平的D-二聚体。

Objective:To investigate the predictive value of Wells score combined with adjusted D-dimers for lung cancer complicated with acute pulmonary embolism.Methods:From November 2013 to November 2020,130 lung cancer patients suspected for APE were admitted to the affiliated hospital of Chengde Medical University.The predictive value of Wells score,adjusted D-dimer and combination of the above were respectively estimated.Results:Among 130 APE suspected cases,67 were confirmed.After Wells scoring,patients were divided into low-potential group(41 cases),medium-potential group(72 cases),high-potential group(17 cases),and confirmed APE were 14 cases,39 cases,33 cases respectively.The sensitivity of diagnosis of lung cancer combining APE was 20.90%,58.21%,20.90%respectively.The specificity was 57.14%,47.62%,95.24%respectively.The positive predictive values were 34.15%,54.17%,82.35%respectively.The negative predictive values were 65.85%,45.83%and 7.65%respectively.The adjusted D-dimer value(981ng/mL),compared with the traditional D-dimer value(500ng/mL),has an increased specificity of diagnosis of lung cancer with APE(42.86%vs23.81%,P<0.05).To the negative patients whose Wells score revealed low potential of combining adjusted D-dimer negative,the negative predictive value of diagnosis of lung cancer combining APE can rise to 99.45%.ROC curves of D-dimers in 130 lung cancer patients with suspected APE reveal that the critical value of D-dimer is 1975ng/mL,higher than the conventional 500ng/mL.Conclusion:Wells score of low potential of combining adjusted D-dimer negative is effective to exclude suspected APE patients with lung cancer.Lung cancer patients with APE often have a high level of D-dimer.