Cheng Z, Yang M, Zhang Z, Dai L L, Wang X, Jia L Q, Jing X G, Jiang T C, An L, Liu M, Yang Y J, Li W F, Li Y, Sun D
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2018 Dec 25;98(48):3925-3929. doi: 10.3760/cma.j.issn.0376-2491.2019.48.004.
To evaluate the predictive value of Wells score, revised Geneva score combined with D-dimer for the risk of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In this study, 234 AECOPD patients underwent CT pulmonary angiography from March 1, 2013 to December 31, 2015 in the First Affiliated Hospital of Zhengzhou University. The basic data of the patients were collected and the patients were classified into AECOPD combined with pulmonary embolism group(pulmonary embolism group) and AECOPD group according to CT pulmonary angiography results. All patients were scored by Wells score and revised Geneva score. The receiver operating characteristic (ROC) curves were generated and the test was applied to evaluate the predictive value by comparing the area under the ROC curves (AUC). Totally 32(13.7%) patients had pulmonary embolism out of the 234 AECOPD patients. The AUC by Wells score, revised Geneva score, D-dimer, Wells score + D-dimer, revised Geneva score + D-dimer were 0.869 (95% 0.789-0.949), 0.710 (95% 0.588-0.832), 0.866 (95% 0.790-0.941), 0.926 (95% 0.874-0.977), 0.855 (95% 0.751-0.959). The AUC of Wells score and D-dimer were significantly greater than that of revised Geneva score (=2.14, 2.12, both <0.05); the AUC of Wells score + D-dimer was significantly greater than revised Geneva score + D-dimer (=2.73, <0.05). The predictive value of Wells score + D-dimer for pulmonary embolism in AECOPD patients is higher than revised Geneva score + D-dimer.
评估Wells评分、改良Geneva评分联合D-二聚体对慢性阻塞性肺疾病急性加重期（AECOPD）患者肺栓塞风险的预测价值。本研究纳入了2013年3月1日至2015年12月31日在郑州大学第一附属医院接受CT肺动脉造影的234例AECOPD患者。收集患者的基本资料，并根据CT肺动脉造影结果将患者分为AECOPD合并肺栓塞组（肺栓塞组）和AECOPD组。所有患者均采用Wells评分和改良Geneva评分进行评分。绘制受试者工作特征（ROC）曲线，并应用检验通过比较ROC曲线下面积（AUC）来评估预测价值。234例AECOPD患者中，共有32例（13.7%）发生肺栓塞。Wells评分、改良Geneva评分、D-二聚体、Wells评分+D-二聚体、改良Geneva评分+D-二聚体的AUC分别为0.869（95% 0.789 - 0.949）、0.710（95% 0.588 - 0.832）、0.866（95% 0.790 - 0.941）、0.926（95% 0.874 - 0.977）、0.855（95% 0.751 - 0.959）。Wells评分和D-二聚体的AUC显著高于改良Geneva评分（Z = 2.14、2.12，均P < 0.05）；Wells评分+D-二聚体的AUC显著高于改良Geneva评分+D-二聚体（Z = 2.73，P < 0.05）。Wells评分+D-二聚体对AECOPD患者肺栓塞的预测价值高于改良Geneva评分+D-二聚体。
