[联合 Wells 评分与 D - 二聚体检测在诊断深静脉血栓形成患者中的价值]

[Value of combined wells score and D-dimer test on diagnosing patients with deep venous thrombosis].

作者信息

Zhu Li, Wang Jian-Guo, Liu Min, Guo Xiao-Juan, Guo Yu-Lin, Guo You-Min, Wang Chen

机构信息

Radiology Department, Affiliated Hospital of Ningxia Medical University, Yinchuan 750004, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Sep;37(9):818-22.

PMID:20128381

Abstract

OBJECTIVE

To evaluate the value of Wells score or/and D-dimer test on diagnosing or excluding deep venous thrombosis (DVT).

METHODS

Patients with suspected DVT were retrospectively analyzed. All patients underwent clinical assessment, D-dimer assay and bilateral lower extremity compression sonography within 48 hours of admission. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing DVT by Wells score, D-dimer test, and combined Wells score and D-dimer were compared.

RESULTS

A total of 274 patients were analyzed. If low probability was defined as negative and moderate and high probabilities were defined as positive, the sensitivity, specificity, PPV and NPV of the Wells score were 78.4%, 66.1%, 52.3% and 86.6%, respectively. At a cut-off of 500 microg/L, the sensitivity, specificity, PPV and NPV of D-dimer test were 73.9%, 66.1%, 50.8% and 84.2%, respectively. If low probability and D-dimer < 500 microg/L were defined as negative, moderate and high probabilities and D-dimer > or = 500 microg/L were defined as positive, the sensitivity, specificity, PPV and NPV of the combined Wells score and D-dimer test were 88.3%, 76.8%, 67.1% and 92.5%, respectively.

CONCLUSION

For clinical suspected DVT patients, DVT diagnosis could be reliably obtained by combined Wells score and D-dimer test.

摘要

目的

评估Wells评分或/和D-二聚体检测在诊断或排除深静脉血栓形成（DVT）方面的价值。

方法

对疑似DVT的患者进行回顾性分析。所有患者在入院48小时内均接受了临床评估、D-二聚体检测及双侧下肢加压超声检查。比较了Wells评分、D-二聚体检测以及Wells评分与D-二聚体联合检测诊断DVT的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。

结果

共分析了274例患者。若将低概率定义为阴性，中、高概率定义为阳性，则Wells评分的敏感性、特异性、PPV和NPV分别为78.4%、66.1%、52.3%和86.6%。以500μg/L为临界值时，D-二聚体检测的敏感性、特异性、PPV和NPV分别为73.9%、66.1%、50.8%和84.2%。若将低概率且D-二聚体<500μg/L定义为阴性，中、高概率且D-二聚体≥500μg/L定义为阳性，则Wells评分与D-二聚体联合检测的敏感性、特异性、PPV和NPV分别为88.3%、76.8%、67.1%和92.5%。