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目的评价血浆D-二聚体结合Wells临床评估量表对肺栓塞的早期诊断价值。方法 100例疑似肺栓塞患者进行回顾性分析,用D-二聚体、Wells临床评估量表及两者结合方法作为诊断标准对肺栓塞进行诊断,并与16排螺旋CT肺动脉血管造影的诊断结果进行比较分析。结果 D-二聚体对中心型和周围型肺栓塞灵敏度分别为88.7%,80.9%;阴性预测值分别为96.3%,97.9%;Youden指数分别为0.43,0.31。Wells临床估量表对中心型和周围型肺栓塞灵敏度分别为83.9%,66.7%,阴性预测值分别为94.9%,96.5%;Youden指数分别为0.40,0.08。两者结合对近端和远端深静脉血栓灵敏度为98.4%,90.5%;阴性预测值分别为99.3%,98.6%;Youden指数分别为0.42,0.29。结论 D-二聚体和Wells临床评估量表作为疑似肺栓塞常规检查,对肺栓塞的诊断具有筛检价值,便于快速普查,有利于降低医疗费用;两者结合起互补作用,可以增加诊断的准确性。
Objective To evaluate the early diagnostic value of plasma D-dimer and Wells clinical evaluation scale for pulmonary embolism. Methods A total of 100 patients with suspected pulmonary embolism were retrospectively analyzed. Pulmonary embolism was diagnosed by D-dimer, Wells clinical assessment scale and their combination as diagnostic criteria. The diagnostic results of 16-slice spiral CT pulmonary angiography For comparative analysis. Results The sensitivity of D-dimer to central and peripheral pulmonary embolism were 88.7% and 80.9% respectively; the negative predictive values were 96.3% and 97.9% respectively; the Youden indices were 0.43 and 0.31 respectively. Wells clinical assessment of central and peripheral pulmonary embolism sensitivity were 83.9%, 66.7%, respectively, the negative predictive value was 94.9%, 96.5%; Youden index were 0.40,0.08. The combined sensitivity of the two methods was 98.4% and 90.5% for the proximal and distal deep venous thrombosis. The negative predictive values were 99.3% and 98.6%, respectively. The Youden indices were 0.42 and 0.29 respectively. Conclusion D-dimer and Wells clinical assessment scale as a routine examination of suspected pulmonary embolism, the screening of pulmonary embolism has the value of screening for easy census, is conducive to reducing medical costs; the two combined play a complementary role, can increase the diagnostic accuracy.