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目的 评价肺灌注显像结合Wells评分及D-二聚体检查对急性肺血栓栓塞症(APE)的诊断价值.方法 选择2006年1月至2008年12月连续121例疑诊APE的初诊患者,所有患者均进行Wells评分、D-二聚体检查、胸部X线检查及核素肺灌注显像.分别计算肺灌注显像结合X线胸片(Q/X显像)、Q/X显像结合Wells评分或(和)D-二聚体检查用于诊断APE的灵敏度、特异性、阳性预测值和阴性预测值.结果 全部121例患者中,41.3%(50/121)的患者最终诊断为APE;58.7%(71/121)最终排除了APE.Q/X显像示APE阳性者49例(40.5%).Q/X显像的诊断灵敏度、特异性、阳性预测值、阴性预测值分别为86.0%(43/50)、91.5%(65/71)、87.8%(43/49)和90.3%(65/72).Q/X显像对于Wells评分>4且D-二聚体阳性(≥0.5 mg/L)的患者,其APE阳性预测值为100.0%(29/29);Q/X显像对Wells评分≤4且D-二聚体阴性(<0.5 mg/L)的患者,其APE阴性预测值亦为100.0%(41/41).结论 Q/X显像结合Wells评分及D-二聚体检查可以有效提高Q/X显像诊断APE的阳性预测值和阴性预测值,从而更准确地诊断APE.

Objective To investigate the value of the Wells score and D-dimer assay in assisting pulmonary perfusion imaging (PPI) for the diagnosis of acute pulmonary embolism (APE). Methods One hundred twenty-one patients with suspected APE were studied from January, 2006 to December, 2008. All patients underwent the Wells score, the quantitative D-dimer assay, chest X-ray photography, and PPI. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of PPI with the assistance of Wells score and D-dimer assay were calculated. Results Fifty (41.3%) patients were diagnosed with APE. PPI combined with chest X-ray photography (Q/X scan) showed positive results in 49 patients. The sensitivity, specificity, positive predictive value and negative predictive value of the Q/X scan were 86.0% (43/50), 91.5% (65/71), 87.8% (43/49) and 90.3% (65/72), respectively. With assistance of Wells score >4 and D-dimer≥0. 5 mg/L, Q/X scan had a positive predictive value of 100.0% (29/29), for patients with Wells score ≤4 and D-dimer<0.5 mg/L, the negative predictive value for Q/X scan was 100.0% (41/41). Conclusion Combined with Wells score and D-dimer assay, PPI can make accurate diagnosis of APE.