调整阈值的D-二聚体联合Wells评分、修正Geneva评分诊断下肢深静脉血栓形成患者非高危肺血栓栓塞症风险的价值

The clinical value of age-adjusted D-dimer cut-off value combined with Wells score,revised Geneva score in diagnosing non-high-risk pulmonary thromboembolism in patients with lower extremity deep venous thrombosis

目的评价根据年龄断层调整的D-二聚体阈值水平联合Wells评分、修正Geneva评分对下肢深静脉血栓形成(DVT)患者非高危肺血栓栓塞症(PTE)风险的诊断价值。方法选取2018年8月1日至2021年5月30日在南通大学附属医院住院的下肢DVT患者为研究对象。根据CT肺动脉造影结果,将患者分为单纯下肢DVT组和伴非高危PTE组。分析两组患者调整阈值的D-二聚体阳性比例、Wells评分、修正Geneva评分,绘制受试者工作特征曲线(ROC),以评价诊断伴非高危PTE风险的价值。结果入组475例患者中单纯下肢DVT组346例(72.8%),伴非高危PTE组129例(27.2%)。调整阈值的D-二聚体、Wells评分、修正Geneva评分、调整阈值的D-二聚体+Wells评分、调整阈值的D-二聚体+修正Geneva评分诊断下肢DVT伴非高危PTE的ROC曲线下面积(AUC)分别为0.553(95%CI=0.497~0.610)、0.724(95%CI=0.670~0.779)、0.698(95%CI=0.645~0.750)、0.751(95%CI=0.701~0.802)、0.727(95%CI=0.678~0.777)。Wells评分、修正Geneva评分AUC均大于调整阈值的D-二聚体,调整阈值的D-二聚体+Wells评分AUC大于调整阈值的D-二聚体+修正Geneva评分。结论调整阈值的D-二聚体联合Wells评分对下肢DVT伴非高危PTE的诊断价值较高。

Objective To evaluate age-adjusted D-dimer cut-off value combined with Wells score,revised Geneva score in diagnosing non-high-risk pulmonary thromboembolism(PTE)in patients with deep venous thrombosis(DVT)of lower extremity.Methods The patients with DVT of lower extremity,who were hospitalized at the Affiliated Hospital of Nantong University of China between August 1,2018 and May 30,2021,were collected as the subjects of this study.According to the results of CT pulmonary angiography,the patients were divided into pure lower extremity DVT group(group A)and lower extremity DVT combined with non-high-risk PTE group(group B).The positive ratio of the age-adjusted D-dimer cut-off value,the Wells score and the revised Geneva score of the two groups were analyzed.The receiver operating characteristic(ROC)curves were drawn to assess its value in diagnosing the non-high-risk PTE.Results A total of 475 patients were enrolled in this study,including 346 patients of group A(72.8%)and 129 patients of group B(27.2%).The area under ROC curve(AUC)of the age-adjusted D-dimer cut-off value,Wells score,revised Geneva score,Wells score+the age-adjusted D-dimer cut-off value,and revised Geneva score+the age-adjusted D-dimer cutoff value were 0.553(95%CI=0.497-0.610),0.724(95%CI=0.670-0.779),0.698(95%CI=0.645-0.750),0.751(95%CI=0.701-0.802)and 0.727(95%CI=0.678-0.777),respectively.The AUC of both Wells score and revised Geneva score were greater than that of the age-adjusted D-dimer cut-off value.The AUC of Wells score+the age-adjusted D-dimer cut-off value was significantly greater than that of revised Geneva score+the age-adjusted D-dimer cut-off value.Conclusion The Wells score+the age-adjusted D-dimer cut-off value has higher diagnostic value for non-high-risk PTE in patients with lower extremity DVT.(J Intervent Radiol,2022,31:1089-1092)