血小板参数联合Wells评分对肺血栓栓塞症诊断及预后的评估价值

Evaluated value of platelet parameters combined with Wells score in the diagnosis and prognosis of pulmonary thromboembolism

目的:探讨血小板参数联合肺栓塞临床预测评分(Wells评分)对肺血栓栓塞症(PTE)诊断及预后的评估价值。方法:选取120例疑似PTE患者为研究对象,根据多层CT肺动脉造影(CTPA)结果分为PTE组(n=88)和非PTE组(n=32);PTE组患者再根据30 d内预后分为死亡组(n=18)和存活组(n=70)。比较PTE组与非PTE组、PTE组不同预后患者血小板参数[血小板计数(PLT)、平均血小板体积(MPV)、血小板体积分布宽度(PDW)]及Wells评分,分析Wells评分联合血小板参数诊断PTE的价值及其与死亡事件的相关性。结果:PTE组患者PLT低于非PTE组(P<0.05);MPV、PDW及Wells评分高于非PTE组(P<0.05)。ROC曲线分析显示,PLT、MPV、PDW联合诊断PTE敏感度、特异度分别为80.68%、78.13%;以CTPA为金标准,Wells评分联合血小板参数诊断PTE的准确度为90.83%。死亡组患者PLT低于存活组(P<0.05),MPV、PDW及Wells评分高于存活组(P<0.05)。相关性分析显示,PTE患者死亡事件与PLT负相关(P<0.05);与MPV、PDW及Wells评分正相关(P<0.05)。结论:PLT、MPV、PDW联合Wells评分诊断PTE与CTPA一致性较高,对预后判断有一定参考价值。

Objective:To explore the evaluated value of platelet parameters combined with clinical prediction score for pulmonary embolism(Wells score)in the diagnosis and prognosis of pulmonary thromboembolism(PTE).Methods:120 patients with suspected PTE were enrolled as research subjects.According to the results of multislice CT pulmonary angiography(CTPA),the patients were divided into PTE group(n=88)and non-PTE group(n=32).According to the prognosis within 30 days,the patients in PTE group were further classified into death group(n=18)and survival group(n=70).The platelet parameters[platelet count(PLT),mean platelet volume(MPV),platelet volume distribution width(PDW)]and Wells score of patients with different prognosis in PTE group,non PTE group and PTE groups were compared,the value of Wells score combined with platelet parameters in diagnosing PTE and its correlation with mortality events were analyzed.Results:The PLT in PTE group was lower than that in non-PTE group(P<0.05),while the MPV,PDW and Wells score were higher than those in non-PTE group(P<0.05).ROC curve showed that the sensitivity and specificity of combined diagnosis were 80.68%and 78.13%.Using CTPA as the gold standard,the accuracy of Wells score combined with platelet parameters in diagnosing PTE was 90.83%.The PLT in death group was lower while the MPV,PDW and Wells score were higher than those in survival group(P<0.05).Correlation analysis showed that the death events in PTE patients were negatively correlated with PLT and positively correlated with MPV,PDW and Wells scores(P<0.05).Conclusion:PLT,MPV and PDW combined with Wells score in the diagnosis of PTE has high consistency with CTPA,and it has certain reference value on prognosis judgement.