本文選題：肺栓塞　切入點：主動脈夾層　出處：《中國老年學雜志》2017年03期

【摘要】：目的 探討D-二聚體和Wells評分在主動脈夾層和急性肺栓塞鑒別診斷中的應用。方法 回顧性分析行胸痛二聯(lián)CT血管造影術(CTA)檢查的住院患者的一般資料、D-二聚體、Wells評分量表,探討Wells評分聯(lián)合D-二聚體對鑒別診斷急性肺栓塞和主動脈夾層的預測價值。結果行胸痛二聯(lián)CTA檢查的全部患者中,確診為肺動脈栓塞者56例,確診率為25%;確診為主動脈夾層患者72例,確診率為33%;余92例未見明顯異常,占42%。Wells評分、D-二聚體及二者聯(lián)合預測肺栓塞時,曲線下面積分別是0.859(95%CI:0.803~0.915),0.783(95%CI:0.723~0.843),0.924(95%CI:0.885~0.963),聯(lián)合預測肺栓塞時曲線下面積明顯增大。Wells評分與D-二聚體聯(lián)合預測肺動脈栓塞的最佳截點為Wells評分2分,主動脈夾層1 650.00μg/L,敏感性94.6%,特異性78.0%。而當D-二聚體升高并低于1 650μg/L時,主動脈夾層組中Wells評分≤1分的患者比例明顯高于肺栓塞及正常對照組。結論 D-二聚體對主動脈夾層或肺栓塞的臨床預測敏感性較高,但特異性較差;Wells評分對肺栓塞的臨床預測敏感性低,特異性較高。Wells評分聯(lián)合D-二聚體對肺栓塞、主動脈夾層的臨床預測有明確意義:當Wells評分≥2分、D-二聚體≥1 650μg/L時,臨床上更傾向肺栓塞的可能;當Wells評分≤1分、D-二聚體升高(≥500μg/L)并1 650μg/L時,臨床上更傾向主動脈夾層的可能。
[Abstract]:Objective to investigate the application of D- two dimer and Wells score in the diagnosis of aortic dissection and acute pulmonary embolism. Methods a retrospective analysis of two chest CT angiography (CTA) examination of the general data of hospitalized patients with D-, two dimers, Wells scale, to explore the combination of two D- dimer to prediction value identification the diagnosis of acute pulmonary embolism and aortic dissection. Results the Wells scores of all patients underwent chest pain two CTA examination in the diagnosis of pulmonary artery embolism in 56 cases, the diagnosis rate was 25%; 72 cases were diagnosed with aortic dissection, the diagnosis rate was 33%; 92 cases had no obvious abnormalities, 42%.Wells score, D- two the dimer and the two combined prediction of pulmonary embolism, the area under the curve was 0.859 (95%CI:0.803~0.915), 0.783 (95%CI:0.723~0.843), 0.924 (95%CI:0.885~0.963), the combined prediction of pulmonary embolism under curve area increased significantly with the.Wells score two D- dimer combined pre The best cut-off point of measurement of pulmonary embolism Wells score 2, aortic dissection 1650 g/L, sensitivity 94.6%, specificity 78.0%. when D- two dimer increased and less than 1650 g/L, Wells group of aortic dissection in 1 or less were the proportion of patients with pulmonary embolism and was significantly higher than that of normal control group. Conclusion D- two the dimer is sensitive to the clinical prediction of aortic dissection or pulmonary embolism, but the specificity is low; the Wells scores of clinical prediction of pulmonary embolism with low sensitivity, high specificity.Wells score combined with two D- dimer in pulmonary embolism, there is a clear significance of clinical predictors of aortic dissection: when Wells score more than 2 points, D- two poly the body of more than 1650 g/L, clinical pulmonary embolism may be more likely; when the Wells score less than 1 points, two D- dimer increased (more than 500 g/L and 1650 g/L), the clinical tend of aortic dissection.

【作者單位】： 吉林大學第一醫(yī)院;
【分類號】：R563.5

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本文編號：1685824