Mironov A V, Leont'ev S G, Ustinov F S, Efremova O I, Lebedev I S, Kirienko A I
Ter Arkh. 2013;85(4):11-5.
To detect the most important clinical symptoms suggesting pulmonary thromboembolism (PTE) and to determine the diagnostic value of the scales used to estimate the likelihood of its occurrence.
The prospective study included 130 patients admitted to hospital with a diagnosis of PTE and a referral for a surgery clinic. Scores of the likelihood of PTE were estimated using the Canada and Geneva scales in all the patients on admission.
In all the patients with suspected PTE, the Canadian and revised Geneva scores averaged 4.2 +/- 0.48 and 6.21 +/- 0.5, respectively. These scores correspond to the intermediate clinical probability of PTE. In 96 patients whose diagnosis was verified by instrumental studies, the Canadian and Geneva scores were 4.41 +/- 0.57 and 6.17 +/- 0.63, respectively, which was also consistent with the intermediate clinical probability of PTE. In 34 patients, whose diagnosis of PTE was ruled out, the average scores did not virtually differ from those in the patients with the verified diagnosis and were 6.14 +/- 1.3 and 4.18 +/- 0.87, respectively. The area under characteristic curve for the Canadian scale was 0.428 and that for the Geneva scale was 0.512. With the use of a two-level interpretation system, a total of more than 6 Canadian scores and 10 Geneva scores suggested that there was a high probability of PTE.
The investigation indicated the low value of integral systems for estimating the likelihood of PTE in the total population of patients with this disease. The authors recommend the two-level interpretation system, in which a total of more than 6 Canadian scores and 10 Geneva scores were identified with a high probability (up to 80%) of PTE.
检测提示肺血栓栓塞症（PTE）的最重要临床症状，并确定用于评估其发生可能性的量表的诊断价值。
前瞻性研究纳入了130例因PTE诊断入院并转诊至外科门诊的患者。所有患者入院时均使用加拿大和日内瓦量表评估PTE发生的可能性评分。
在所有疑似PTE的患者中，加拿大量表和修订版日内瓦量表的评分分别平均为4.2±0.48和6.21±0.5。这些评分对应于PTE的中度临床概率。在96例经影像学检查确诊的患者中，加拿大量表和日内瓦量表的评分分别为4.41±0.57和6.17±0.63，这也与PTE的中度临床概率一致。在34例PTE诊断被排除的患者中，平均评分与确诊患者的评分几乎没有差异，分别为6.14±1.3和4.18±0.87。加拿大量表的特征曲线下面积为0.428，日内瓦量表的特征曲线下面积为0.512。使用两级解读系统时，加拿大量表总分超过6分和日内瓦量表总分超过10分提示PTE发生的可能性很大。
该研究表明在患有这种疾病的患者总体中，积分系统评估PTE发生可能性的价值较低。作者推荐两级解读系统，即加拿大量表总分超过6分和日内瓦量表总分超过10分提示PTE发生的可能性很大（高达80%）。
