3种评分方法对急性肺栓塞诊断的预测价值比较

王悦悦; 许启霞; 姚宇婷; 王杭; 陈蕾

doi:10.16766/j.cnki.issn.1674-4152.002399

3种评分方法对急性肺栓塞诊断的预测价值比较

doi: 10.16766/j.cnki.issn.1674-4152.002399

王悦悦¹,
许启霞^{1, 2, ,},
姚宇婷¹,
王杭¹,
陈蕾¹

1.
蚌埠医学院第一附属医院呼吸与危重症医学科，安徽蚌埠 233004
2.
中国科学技术大学附属第一医院呼吸与危重症医学科，安徽合肥 230000

基金项目:

国家“十三五”重点研发计划精准医学专项 2016YFC0905600

蚌埠医学院2020年度研究生科研创新计划 Byycx20072

详细信息

通讯作者:
许启霞，E-mail：xuqixia11@sina.com

中图分类号: R563.5
计量
- 文章访问数: 229
- HTML全文浏览量: 114
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2021-11-19
- 网络出版日期: 2022-08-20

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

1.
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 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。
- 肺栓塞 /
- 诊断 /
- 临床评分 /
- YEARS评分 /
- D-二聚体
Abstract: 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.
- Pulmonary embolism /
- Diagnosis /
- Clinical score /
- YEARS algorithm /
- D-dimer

HTML全文

图 1 YEARS法评估标准

Figure 1. Evaluation standard of YEARS algorithm

下载: 全尺寸图片幻灯片

图 2 676例疑诊急性肺栓塞患者分组情况

Figure 2. Grouping of 676 patients suspected of acute pulmonary embolism

下载: 全尺寸图片幻灯片

图 3 3种评分方法预测急性肺栓塞的ROC曲线

Figure 3. ROC curves of three scoring methods for predicting acute pulmonary embolism

下载: 全尺寸图片幻灯片

表 1 2组疑诊急性肺栓塞患者一般特征和血浆D-二聚体比较

Table 1. Comparison of general characteristics and plasma D-dimer in 2 groups of patients suspected of acute pulmonary embolism

组别	例数	年龄 (x±s, 岁)	性别 (男/女, 例)	心率 (x±s, 次/min)	D-二聚体 (x±s, mg/L)
CTPA阳性组	174	63.76±15.38	103/71	94.14±18.22	11.68±20.31
CTPA阴性组	502	62.07±15.57	281/221	87.67±17.13	6.57±12.55
统计量		1.237^a	0.546^b	4.225^a	3.881^a
P值		0.217	0.460	＜0.001	＜0.001
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 2 YEARS评分、简化的Wells评分和修正的Geneva评分与CT肺动脉造影的一致性检验

Table 2. Consistency tests of the YEARS algorithm, simplified Wells scores and modified Geneva with CT pulmonary angiography findings

项目	灵敏度(95% CI)	特异度(95% CI)	阳性预测值(95% CI)	阴性预测值(95% CI)	阳性似然比(95% CI)	阴性似然比(95% CI)
YEARS评分	89.66%(83.91%~93.58%)	35.06%(30.92%~39.43%)	32.37%(28.24%~36.77%)	90.72%(85.51%~94.25%)	1.38(1.27~1.50)	0.29(0.41~0.55)
简化Wells评分	66.09%(58.48%~72.98%)	71.91%(67.72%~75.76%)	44.92%(38.75%~51.24%)	85.95%(82.17%~89.06%)	2.35(1.97~2.81)	0.47(0.38~0.58)
修正的Geneva评分	62.07%(54.38%~69.21%)	65.74%(61.38%~69.85%)	38.57%(32.89%~44.57%)	83.33%(79.21%~86.79%)	1.81(1.53~2.14)	0.58(0.48~0.70)

下载: 导出CSV

表 3 不同倍数D-二聚体的阈值联合简化的Wells评分与CT肺动脉造影的一致性检验

Table 3. Consistency tests of different D-dimer thresholds combined with simplified Wells score and CT pulmonary angiography findings

项目	灵敏度(95% CI)	特异度(95% CI)	阳性预测值(95% CI)	阴性预测值(95% CI)	阳性似然比(95% CI)	阴性似然比(95% CI)
Wells评分+D-二聚体≥0.5 mg/L	63.22%(55.55%~70.30%)	74.70%(70.62%~78.40%)	46.41%(39.97%~52.98%)	85.42%(81.69%~88.52%)	2.49(2.07~3.02)	0.49(0.40~0.60)
Wells评分+D-二聚体≥1.0 mg/L	58.62%(50.91%~65.95%)	77.09%(73.11%~80.65%)	47.00%(40.25%~53.87%)	84.31%(80.59%~87.45%)	2.56(2.09~3.14)	0.54(0.45~0.64)
Wells评分+D-二聚体≥1.5 mg/L	55.75%(48.04%~63.20%)	79.28%(75.42%~85.69%)	48.26%(41.20%~55.38%)	83.79%(80.09%~86.93%)	2.69(2.17~3.34)	0.56(0.47~0.66)
Wells评分+D-二聚体≥2.0 mg/L	52.30%(44.63%~59.87%)	81.08%(77.31%~84.35%)	48.92%(41.57%~56.32%)	83.06%(79.38%~86.22%)	2.76(2.10~3.48)	0.59(0.50~0.69)

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参考文献(20)

[1]	KLINE J A. Diagnosis and exclusion of pulmonary embolism[J]. Thromb Res, 2018, 163: 207-220. doi: 10.1016/j.thromres.2017.06.002
[2]	RIGHINI M, ROBERT-EBADI H. Diagnosis of acute pulmonary embolism[J]. Hamostaseologie, 2018, 38(1): 11-21. doi: 10.5482/HAMO-17-07-0023
[3]	VAN ES J, BEENEN L F, DOUMA R A, et al. A simple decision rule including D-dimer to reduce the need for computed tomography scanning in patients with suspected pulmonary embolism[J]. J Thromb Haemost, 2015, 13(8): 1428-1435. doi: 10.1111/jth.13011
[4]	VAN DER HULLE T, CHEUNG W Y, KOOIJ S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): A prospective, multicentre, cohort study[J]. Lancet(London, England), 2017, 390(10091): 289-297.
[5]	KONSTANTINIDES S V, MEYER G. The 2019 ESC guidelines on the diagnosis and management of acute pulmonary embolism[J]. Eur Heart J, 2019, 40(42): 3453-3455. doi: 10.1093/eurheartj/ehz726
[6]	荆文花, 李鸿宇, 关英慧. Wells评分和YEARS法对肺栓塞诊断价值的比较[J]. 吉林大学学报(医学版), 2019, 45(1): 88-93. https://www.cnki.com.cn/Article/CJFDTOTAL-BQEB201901017.htm JING W H, LI H Y, GUAN Y H. Comparison of values between Wells score and YEARS algorithm in the diagnosis of pulmonary embolism[J]. Journal of Jilin University (Medical Science Edition), 2019, 45(1): 88-93. https://www.cnki.com.cn/Article/CJFDTOTAL-BQEB201901017.htm
[7]	ABDELAAL AHMED MAHMOUD M A A, DONNELLY M, SNYMAN L, et al. YEARS algorithm versus Wells ' score: Predictive accuracies in pulmonary embolism based on the gold standard CT pulmonary angiography[J]. Crit Care Med, 2020, 48(5): 704-708. doi: 10.1097/CCM.0000000000004271
[8]	韩婧, 邵翔, 刘敏, 等. 基于YEARs评分诊断策略在急性肺栓塞中的临床应用探讨[J]. 中国实用内科杂志, 2021, 41(5): 396-400. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK202105014.htm HAN J, SHAO X, LIU M, et al. Application of diagnosis strategy based on YEARs score in acute pulmonary embolism in Chinese population[J]. Chinese Journal of Practical Internal Medicine, 2021, 41(5): 396-400. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK202105014.htm
[9]	王浙桦, 周宏斌, 袁东, 等. 比较YEARS方案和简化Wells联合方案在可疑急性肺栓塞患者评估中的价值[J]. 中华结核和呼吸杂志, 2020, 43(12): 1055-1060. doi: 10.3760/cma.j.cn112147-20200519-00613 WANG Z H, ZHOU H B, YUAN D, et al. Comparison of the values of the YEARS algorithm and the simplified Wells combined with age-adjusted D-dimer algorithm in the evaluation of patients with suspected acute pulmonary embolism[J]. Chinese Journal of Tuberculosis and Respiration, 2020, 43(12): 1055-1060. doi: 10.3760/cma.j.cn112147-20200519-00613
[10]	王辰. 肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018, 98(14): 1060-1087. doi: 10.3760/cma.j.issn.0376-2491.2018.14.007 WANG C. Guidelines for diagnosis, treatment and prevention of pulmonary thromboembolism[J]. Chinese Medical Journal, 2018, 98(14): 1060-1087. doi: 10.3760/cma.j.issn.0376-2491.2018.14.007
[11]	LIM L H, HAYES A G, TOH D J. Use of a three-tiered clinical decision rule to quantify unnecessary radiological investigation of suspected pulmonary embolism[J]. Intern Med J, 2019, 49(11): 1371-1377. doi: 10.1111/imj.14234
[12]	王悦悦, 许启霞. 可疑肺栓塞诊断新策略-YEARS评分[J]. 中国全科医学, 2021, 24(26): 3383-3386, 3391. doi: 10.12114/j.issn.1007-9572.2021.01.007 WANG Y Y, XU Q X. YEARS Algorithm: A new diagnostic strategy for suspected pulmonary embolism[J]. Chinese General Practice, 2021, 24(26): 3383-3386, 3391. doi: 10.12114/j.issn.1007-9572.2021.01.007
[13]	VAN DER POL L M, DRONKERS C E A, VAN DER HULLE T, et al. The YEARS algorithm for suspected pulmonary embolism: Shorter visit time and reduced costs at the emergency department[J]. J Thromb Haemost, 2018, 16(4): 725-733. doi: 10.1111/jth.13972
[14]	VAN DER POL L M, BISTERVELS I M, VAN MENS T E, et al. Lower prevalence of subsegmental pulmonary embolism after application of the YEARS diagnostic algorithm[J]. Br J Haematol, 2018, 183(4): 629-635. doi: 10.1111/bjh.15556
[15]	VAN DER POL L M, TROMEUR C, BISTERVELS I M, et al. Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism[J]. N Engl J Med, 2019, 380(12): 1139-1149. doi: 10.1056/NEJMoa1813865
[16]	LANGLOIS E, CUSSON-DUFOUR C, MOUMNEH T, et al. Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT-PE-pregnancy study[J]. J Thromb Haemost, 2019, 17(8): 1329-1334. doi: 10.1111/jth.14483
[17]	MOORE A J E, WACHSMANN J, CHAMARTHY M R, et al. Imaging of acute pulmonary embolism: An update[J]. Cardiovasc Diagn Ther, 2018, 8(3): 225-243. doi: 10.21037/cdt.2017.12.01
[18]	VAN ES N, KRAAIJPOEL N, KLOK F A, et al. The original and simplified Wells rules and age-adjusted D-dimer testing to rule out pulmonary embolism: An individual patient data meta-analysis[J]. J Thromb Haemost, 2017, 15(4): 678-684. doi: 10.1111/jth.13630
[19]	彭寸敬, 丁红艳, 王亚飞, 等. 血浆D二聚体联合Wells评分对急性肺栓塞病情及预后评估价值[J]. 临床误诊误治, 2019, 32(5): 77-81. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWZ201905018.htm PENG C J, DING H Y, WANG Y F, et al. Value of plasma D-dimer combined with Wells Score in evaluating the condition and prognosis of patients with acute pulmonary embolism[J]. Clinical Misdiagnosis and Mismanagement, 2019, 32(5): 77-81. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWZ201905018.htm
[20]	姚宇婷, 许启霞, 庞颖颖, 等. 恶性肿瘤合并静脉血栓栓塞症临床特征分析及预测模型的评估[J]. 中华全科医学, 2021, 19(5): 723-726, 808. doi: 10.16766/j.cnki.issn.1674-4152.001901 YAO Y T, XU Q X, PANG Y Y, et al. Analysis of clinical characteristics of malignant tumors complicated with venous thromboembolism and evaluation of predictive models[J]. Chinese Journal of General Practice, 2021, 19(5): 723-726, 808. doi: 10.16766/j.cnki.issn.1674-4152.001901