摘要目的 探讨Wells评分联合年龄校正D-二聚体对住院患者急性肺栓塞(APE)的诊断价值.方法 回顾性分析2010年10月至2018年11月在汕头市中心医院住院的疑似APE患者(≥50岁)555例,以CT肺动脉造影(CTPA)为诊断标准,评价Wells评分、年龄校正D-二聚体[(年龄×10) μg/L]和两者联合对APE的诊断价值.结果 经CTPA确诊的APE有213例;Wells评分为低度、中度和高度可能APE患者分别为290、224、41例;Wells评分低度可能、中度可能和高度可能诊断APE的敏感度分别为24.41％ 、57.28％和18.31％,特异度分别为30.41％、70.18％和99.42％,阳性预测值分别为17.93％、54.46％和95.12％,阴性预测值分别为82.07％、45.54％和4.88％;年龄校正D-二聚体诊断APE的敏感度为89.20％,特异度为40.06％,阳性预测值为48.10％,阴性预测值为85.63％;Wells评分低度可能与年龄校正D-二 聚体联合,可进一步提高阴性预测值至93.04％.结论 Wells评分为低度可能联合年龄校正D-二聚体阴性对排除疑似APE有较高的临床价值.

abstractsObjective To investigate the diagnostic value of Wells score combined with age-adjusted D-dimer (AADD) standard in acute pulmonary embolism (APE) in inpatients.Methods A total of 555 inpatients (over 50 years old) with suspected APE from Shantou Central Hospital during October 2010 and November 2018 were divided into low risk groups (Wells score ＜ 2),intermediate risk groups (Wells score 2-6) and high risk groups (Wells score＞ 6)according to Wells criteria,with spiral CT pulmonary angiography (CTPA) as the diagnostic mehtod of APE.Meanwhile,the plasma concentration of D-dimer was detected and analyzed by immunoturbidimetry in all patients.The AADD cut-off value was (a patint's age× 10) μg/L.Then the sensitivity,specificity,positive predictive value (PPV) and negative predictive value(NPV) of Wells criteria,AADD and their combination for APE diagnosis were calculated and compared respectively.Results Out of 555 cases,213 cases were diagnosed as APE by the CTPA.There were 290,224 and 41 suspected cases which had low,medium and high Wells score respectively.The sensitivity,specificity,PPV and NPV of APE diagnosis for low,medium and high Wells score were 24.41％,57.28％ and 18.31％,30.41％,70.18％ and 99.42％,17.93％,54.46％ and 95.12％,82.07％,45.54％ and 4.88％,respectively.The sensitivity,specificity,PPV and NPV of AADD were 89.20％,40.06％,48.10％ and 85.63％ respectively.Combinning a low risk Wells score with a negative AADD improved the NPV to 93.04％.Conclusions Patients with low Wells score and negative AADD may have higher clinical value in eliminating suspected APE.