修正Geneva评分联合D-二聚体在急性肺栓塞患者早期诊断中的价值评估

蒋云飞; 邵斌霞; 蒋陈晓; 顾双双; 何飞; 黄维; 王军

doi:10.13201/j.issn.1009-5918.2020.05.002

修正Geneva评分联合D-二聚体在急性肺栓塞患者早期诊断中的价值评估

- 1. 南京大学医学院附属鼓楼医院急诊医学科(南京, 210008);
- 2. 江苏省中医院南京中医药大学附属医院肿瘤放疗科
基金项目:
中央高校基本科研业务费专项资金项目(No:021414380146)

江苏省中医药科技项目(No:YB2015073)

南京市医学科技发展项目(No:YKK16074)

详细信息

通讯作者: 王军,E-mail:wjgaogou@aliyun.com

中图分类号: R563.5

收稿日期: 2020-03-29

Evaluation of modified Geneva score combined with D-dimer in early diagnosis of acute pulmonary embolism

- 1. Department of Emergency, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China;
- 2. Department of Radiation Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine

More Information

Corresponding author: WANG Jun, E-mail: wjgaogou@aliyun.com

Received Date: 29 March 2020

摘要

摘要: 目的:评价修正Geneva评分联合D-二聚体在急性肺栓塞(APE)早期的诊断价值。方法:收集2018-01-01—2018-12-31期间南京大学医学院附属鼓楼医院疑似APE住院患者,通过CT肺动脉血管造影(CTPA)结果,将患者分成非肺栓塞组(144例)和肺栓塞组(97例),对两组患者一般资料、伴随疾病、临床症状、体征、修正Geneva评分和D-二聚体等进行统计和分析。结果:两组有恶性肿瘤活动病史、近期手术或骨折病史、单侧下肢肿胀或疼痛、首次就诊心率、修正Geneva评分和D-二聚体差异具有统计学意义(P<0.05);根据多元Logistic回归分析,修正Geneva评分和D-二聚体为APE的高危因素(P<0.05)。应用SPSS 16.0软件绘制修正Geneva评分、D-二聚体和二者联合的ROC曲线。修正Geneva评分、D-二聚体和二者联合的曲线下面积分别为0.830(95%CI:0.778~0.883)、0.883(95%CI:0.839~0.926)和0.922(95%CI:0.889~0.956)。其中修正Geneva评分联合D-二聚体诊断APE敏感度为95.9%,特异度为80.6%。结论:修正Geneva评分联合D-二聚体在APE患者早期诊断中具有重要的价值,值得临床推广和应用。
- 急性肺栓塞 /
- 修正Geneva评分 /
- D-二聚体
Abstract: Objective: To evaluate the clinical value of revised Geneva score combined with D-dimer in the early diagnosis of acute pulmonary embolism(APE). Method: This retrospective study enrolled suspected APE patients in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 1, 2018 to December 31, 2018. According to the results of CT pulmonary angiography(CTPA), the patients were divided into non-APE group(144 cases) and APE group(97 cases). The general information, concomitant diseases, clinical symptoms, signs, revised Geneva scores and D-dimer were analyzed. Result: There were significant differences between the two groups in the history of malignant tumor activity, recent operation or fracture, swelling or pain of unilateral lower extremity, first visit heart rate, revised Geneva score and D-dimer(P<0.05). According to multiple Logistic regression analysis, revised Geneva score and D-dimer were high risk factors for APE(P<0.05). By using SPSS 16.0 software, the ROC curves of revised Geneva score, D-dimer and combined were drawn. The area under revised Geneva score, D-dimer and combined curve were 0.830(95%CI: 0.778-0.883), 0.883(95%CI: 0.839-0.926) and 0.922(95%CI: 0.889-0.956), respectively. The sensitivity and specificity of modified Geneva score combined with D-dimer were 95.9% and 80.6%, respectively.Conclusion: Revised Geneva score combined with D-dimer is of great value in early diagnosis of APE patients, which is worthy of clinical promotion and application.
- acute pulmonary embolism /
- revised geneva score /
- D-dimer

HTML全文

参考文献(17)

[1]	Goldhaber SZ,Visani L,De Rosa M.Acute pulmonary embolism:clinical outcomes in the International Cooperative Pulmonary Embolism Regis-try(ICOPER)[J].Lancet,1999,353(9162):1386-1389.
[2]	Ng AC,Chung T,Yong AS,et al.Long-term cardiovascular and noncardiovascular mortality of 1023 patients with confirmed acute pulmonary embolism[J].Circ Cardiovasc Qual Outcomes,2011,4(1):122-128.
[3]	Huisman MV,Barco S,Cannegieter SC,et al.Pulmonary embolism[J].Nat Rev Dis Primers,2018,4:18028.
[4]	韩丽丽,张永祥,赵莹,等.血清BNP、TnI及D-二聚体水平对急性肺栓塞患者病情及预后评估的价值[J].山东医药,2016,56(44):92-94.
[5]	Wolfe TR,Allen TL.Syncope as an emergency department presentation of pulmonary embolism[J].J Emerg Med,1998,16(1):27-31.
[6]	Shahriar Z,Stephan R,Shw eta M,et al.Could the number of CT angiograms be reduced in emergency department patients suspected of pulmonary embolism?[J].World J Emerg Med,2012,3(3):172-176.
[7]	Wolfe TR,Allen TL.Syncope as an emergency department presentation of pulmonary embolism[J].J Emerg Med,1998,16(1):27-31.
[8]	中华医学会心血管病学分会肺血管病学组.急性肺栓塞诊断与治疗中国专家共识(2015)[J].中华心血管病杂志,2016,44(3):197-211.
[9]	Cohen AT,Agnelli G,Anderson FA,et al.Venous thromboembolism(VTE)in Europe.The number of VTE events and associated morbidity and mortality[J].Thromb Haemost,2007,98(4):756-764.
[10]	Yang Y,Hang L,Zhai Z,et al.Pulmonary embolism incidence and fatality trends in Chinese hospitals from 1997 to 2008:a multicenter registration study[J].PLoS One,2011,6(11):e26861.
[11]	Wicki J,Perneger TV,Junod AF,et al.Assessing clinical probability of pulmonary embolism in the emergency ward:a simple score[J].Arch Intern Med,2001,161(1):92-97.
[12]	Le Gal G,Righini M,Roy PM,et al.Prediction of pulmonary embolism in the emergency department:the revised Geneva score[J].Ann Intern Med,2006,144(3):165-171.
[13]	Kearon C,de Wit K,Parpia S,et al.Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability[J].N Engl J Med,2019,381(22):2125-2134.
[14]	温彦芳,曹丽萍,张炜,等.简化Geneva评分联合年龄校正的D-二聚体对创伤患者急性肺栓塞的预测价值[J].临床急诊杂志,2017,18(3):213-216.
[15]	Donnellan E,Khorana AA.Cancer and Venous Thromboembolic Disease:A Review[J].Oncologist,2017,22(2):199-207.
[16]	Christensen TD,Vad H,Pedersen S,et al.Venous thromboembolism in patients undergoing operations for lung cancer:a systematic review[J].Ann Thorac Surg,2014,97(2):394-400.
[17]	陈旭锋,吕金如,李琳,等.肺栓塞的危险因素、症状与危险分层的相关性分析[J].南京医科大学学报:自然科学版,2017,37(12):1633-1635.