摘要
目的评价临床评分、D-二聚体、下肢超声、心脏超声单项试验及其联合试验对可疑肺血栓栓塞症（VIE）的诊断与排除诊断价值。方法以139例确诊PTE患者为诊断组，入院时疑似但经检查排除PTE的50例患者为对照组。对每位患者进行临床评分及D-二聚体、下肢深静脉超声、心脏超声检查。分别计算单项试验及其并、串联后诊断试验中常用的评价指标，并进行比较。结果Geneva评分高度可能阳性似然比〉10，对PTE有确诊意义。半定量Latex法或定量Latex法检测D-二聚体阴性似然比均〉0．1，不能排除急性VIE；多项并联试验阴性似然比均〈0．1，结果阴性即可排除PTE。Geneva评分高度可能并联下肢超声、心脏超声串联下肢超声Youden指数均〉0．6，对PTE诊断有较大的提示作用。多项并联或串联试验均能提高诊断的灵敏度或特异度。结论Geneva评分客观性较强，高度可能对PET有确诊价值。多项诊断试验并联结果阴性时排除VrE较为可靠。根据诊断目的灵活运用Geneva评分、D-二聚体、下肢超声、心脏超声及其并、串联试验，可降低PTE的漏、误诊率。
Objective To evaluate the value of Geneva score, plasma D-dimer level, lower extremity compressive ultrasonography and transthoracic eehocardiography, as well as their combination, in diagnosis for suspected pulmonary thromboembolism （PTE） and its exclusion. Methods In total, 139 confirmed PTE patients were enrolled in the study, with 50 patients with suspected PTE at admission but excluding PTE after testing as controls. Geneva scores and plasma level of D-dimer were determined, and deep vein ultrasonography in the lower extremity and transthoracic echocardiography were performed for all the confirmed cases of PTE and controls. Diagnostic values were evaluated with each test index alone or in combination, to confirm or exclude PTE. Results PTE could be diagnosed by high Geneva score, with a positive likelihood ratio more than 10 and it could not be excluded by a negative likelihood ratio more than 0. 1 with Latex semi-quantitative method and quantitative method Latex method. PTE could be excluded by a multi-tests in parallel with negative likelihood ratio less than 0. 1. High Geneva scores, in combination with ultrasonography of the lower extremity and transthoracic echoeardiography in combination with Youden index greater than 0. 6 could indicate PTE. Sensitivity and specificity of PTE diagnosis could be improved by multitests in parallel or in series. Conclusions Geneva score is more objective indicator and high score has diagnostic value for PTE. PTE could be excluded reliably by negative result of multi-diagnostic tests in parallel. Misdiagnosis and under-diagnosis for PTE can be reduced by Geneva score, blood D-dimer level, lower extremity compressive uhrasonography and transthoracic echocardiography, as well as their combination, in parallel in hospitals without ECT or spiral CT.
出处
《中华全科医师杂志》
2009年第7期451-454,共4页
Chinese Journal of General Practitioners
关键词
肺栓塞
诊断技术和方法
临床评分
Pulmonary embolism
Diagnostic techniques and procedures
Clinical scores
