3种评分方法对急性肺栓塞诊断的预测价值比较

Comparison of the predictive value of three scoring methods in the diagnosis of acute pulmonary embolism

目的探讨YEARS评分对急性肺栓塞诊断的预测价值,并与2种传统评分对比,以期发现更适合临床疑诊急性肺栓塞的评分模型。方法回顾性分析2018年4月—2020年12月蚌埠医学院第一附属医院因疑诊急性肺栓塞行CT肺动脉造影(CTPA)检查的住院患者676例,以CTPA作为诊断急性肺栓塞的金标准,比较YEARS评分、简化的Wells评分、修正的Geneva评分及不同D-二聚体阈值联合简化Wells评分对急性肺栓塞诊断的预测价值。结果676例患者中174例经CTPA确诊肺栓塞。YEARS评分的灵敏度及阴性预测值(89.66%、90.72%)较简化的Wells评分(66.09%、85.95%)和修正的Geneva评分(62.07%、83.33%)高,但其特异度(35.06%)低于简化的Wells评分(71.91%)和修正的Geneva评分(65.74%)。简化的Wells评分的ROC曲线下面积(0.690)大于YEARS评分(0.624)和修正的Geneva评分(0.639)。简化的Wells评分的诊断优势比(4.99)最高,YEARS评分(4.68)次之,修正的Geneva评分(3.14)最低。将不同D-二聚体的阈值联合简化Wells评分,D-二聚体≥0.5 mg/L联合简化Wells评分时诊断优势比最高(5.08)。结论YEARS评分的灵敏度及阴性预测值最高,诊断效能略低于简化的Wells评分;简化的Wells评分的诊断效能最高,将D-二聚体≥0.5 mg/L联合简化Wells评分时可取得更好的诊断效能。

Objective To examine the predictive value of YEARS algorithm in the diagnosis of acute pulmonary embolism and compare it with two traditional scores in order to find a more suitable scoring model for clinical suspected acute pulmonary embolism.Methods A retrospective analysis was performed on 676 inpatients admitted at the First Affiliated Hospital of Bengbu Medical College from April 2018 to December 2020 who had undergone computed tomographic pulmonary angiography(CTPA)examination due to clinical suspected acute pulmonary embolism.CTPA was used as the gold standard for the diagnosis of acute pulmonary embolism,and the predictive value of YEARS algorithm,simplified Wells score,modified Geneva score and combination of simplified Wells score with different D-dimer thresholds in the diagnosis of acute pulmonary embolism was compared.Results A total of 174 patients were diagnosed with pulmonary embolism by CTPA examination.The sensitivity and negative predictive values of the YEARS algorithm(89.66%and 90.72%)were higher than those of the simplified Wells scores(66.09%and 85.95%)and modified Geneva scores(62.07%and 83.33%).However,its specificity(35.06%)was lower than that of the simplified Wells(71.91%)and modified Geneva(65.74%)scores.The area under curve(AUC)of the simplified Wells score(0.690)was greater than that of the YEARS algorithm(0.624)and the modified Geneva score(0.639).The simplified Wells score had the highest diagnostic odds ratio(DOR,4.99),followed by the YEARS algorithm(4.68)and the modified Geneva score(3.14).In addition,combining the thresholds of different D-dimers to simplify the Wells score,the results showed that combining the simplified Wells score with D-dimer≥0.5 mg/L achieved the highest DOR(5.08).Conclusion The sensitivity and negative predictive value of YEARS algorithm are higher,but the diagnostic efficacy is slightly lower than that of the simplified Wells score.The simplified Wells score has the highest diagnostic efficacy,and combining the simplified Wells score with D-dimer≥0.5 mg/L may help improve the efficacy of pulmonary embolism diagnosis.