摘要
目的探讨血浆D二聚体联合Wells评分对急性肺栓塞(acute pulm onary embolism, APE)病情及预后评估价值。方法选取APE 142例,根据患者病情程度将其分为低危组52例,中危组48例,高危组42例;根据患者预后情况将其分为存活组111例和病死组31例。观察比较不同病情程度及预后APE患者血浆D二聚体水平和Wells评分、急性生理学与慢性健康评定标准Ⅱ(APACHEⅡ)评分的差异性,分析血浆D二聚体、Wells评分与APACHEⅡ评分相关性,并通过受试者工作特征(ROC)曲线分析血浆D二聚体和Wells评分对APE患者病情及预后的评估价值。结果低危组、中危组和高危组血浆D二聚体水平、Wells评分、APACHE II评分及病死率总体比较差异均有统计学意义(P<0.05)。中危组和高危组血浆D二聚体水平、Wells评分、APACHE II评分及病死率均高于低危组,高危组血浆D二聚体水平、Wells评分、APACHE II评分及病死率均高于中危组,差异有统计学意义(P<0.05)。病死组血浆D二聚体水平、Wells评分及APACHE II评分均高于存活组,两组比较差异有统计学意义(P<0.05)。Spearman相关分析结果显示血浆D二聚体、Wells评分与APACHE II评分均呈正相关。单独血浆D二聚体、单独Wells评分及血浆D二聚体联合Wells评分评估APE患者病情及预后的灵敏度和特异度总体比较差异均有统计学意义(P<0.05)。血浆D二聚体联合Wells评分评估APE患者病情及预后的灵敏度和特异度显著高于单独血浆D二聚体和单独Wells评分评估APE患者病情及预后的灵敏度和特异度,差异有统计学意义(P<0.05)。结论血浆D二聚体和Wells评分在APE患者中随着病情加重逐渐上升,血浆D二聚体联合Wells评分对APE患者病情及预后评估有较高的灵敏度和特异度。
ObjectiveTo explore the value of plasma D-dimer combined with Wells score in evaluating the condition and prognosis of patients with acute pulmonary embolism (APE). MethodsA total of 142 APE patients were selected and then were divided into low-risk group (n=52), moderate-risk group (n=48), and high-risk group (n=42) according to the severity of the disease. Based on the prognosis of patients, 142 patients with APE were divided into survival group (n=111) and death group (n=31). The difference in plasma D-dimer level, Wells score, and acute physiology and chronic health evaluation II (APACHE II) score in APE patients with different degrees of severity and different prognosis were observed and compared. The correlation between plasma D-dimer, Wells score and APACHE II score was analyzed, and ROC curves were used to analyze the value of D-dimer and Wells scores in evaluating the condition and prognosis of patients with APE. ResultsThere were significant differences in plasma D-dimer level, Wells score, APACHE II score and mortality rate between low-risk group, moderate-risk group and high-risk group ( P <0.05). The plasma D-dimer level, Wells score, APACHE II score and mortality rate in the moderate-risk group and the high-risk group were higher than those in the low-risk group. The above indicators in the high-risk group were higher than those in the moderate-risk group, and the difference was statistically significant ( P <0.05). Plasma D-dimer level, Wells score and APACHE II score in the death group were higher than those in the survival group, and the difference was statistically significant ( P <0.05). Spearman's correlation analysis showed that there was a positive correlation between plasma D-dimer, Wells score and APACHE II score. The differences were statistically significant in sensitivity and specificity of the plasma D-dimer level alone, the Wells score alone and the plasma D-dimer combined with the Wells score in the evaluating the condition and prognosis of patients with APE ( P <0.05). The sensitivity and specificity of plasma D-dimer combined with Wells score in evaluating the condition and prognosis of patients with APE were significantly higher than those of plasma D-dimer and Wells score alone. And the difference was statistically significant ( P <0.05). ConclusionPlasma D-dimer level and Wells score were increased gradually in patients with APE as the disease worsened. Plasma D-dimer combined with Wells score had higher sensitivity and specificity for the evaluation of APE patients' condition and prognosis.
作者
彭寸敬
丁红艳
王亚飞
董丽娟
PENG Cun-jing;DING Hong-yan;WANG Ya-fei;DONG Li-juan(Department of Clinical Laboratory, The Third Hospital of Shijiazhuang, Shijiazhuang 050000, China;Department of Cardiology, Yixian Hospital, Baoding, Hebei 074200, China)
出处
《临床误诊误治》
2019年第5期77-81,共5页
Clinical Misdiagnosis & Mistherapy
基金
河北省医学科学研究重点课题项目(20181051)
