摘要： 目的 评价PEGeD法及YEARS法对急性肺血栓栓塞的诊断价值。方法 选择疑似急性肺血栓栓塞患者454例，收集病史、临床表现、辅助检查，并进行标准诊断法、PEGeD法及YEARS法评估，以肺动脉血管造影术（CTPA）阳性作为确诊肺血栓栓塞的金标准，计算并比较3种评估方法诊断肺血栓栓塞的灵敏度、特异度，以及受试者工作特征（ROC）曲线下面积。结果 标准诊断法诊断肺血栓栓塞的灵敏度为95.28%，特异度为37.65%。YEARS法诊断肺血栓栓塞的灵敏度为82.76%，特异度为52.16%。PEGeD法诊断肺血栓栓塞的灵敏度为90.76%，特异度为64.50%。标准诊断法、YEARS法及PEGeD法诊断肺血栓栓塞的ROC曲线下面积分别为0.665（95%CI：0.620~0.709），0.672（95%CI：0.627~0.715），0.776（95%CI：0.735~0.814），PEGeD法的ROC曲线下面积大于其他2种方法（P < 0.001）。结论 PEGeD法对急性肺血栓栓塞的诊断价值总体优于标准诊断法及YEARS法。

与临床可能性相适应的D-二聚体水平对急性肺血栓栓塞的诊断价值

刘佳明, 郑锐

中国医科大学附属盛京医院呼吸与危重症医学科, 沈阳 110022

收稿日期:2020-12-25出版日期:2021-08-30发布日期:2021-07-29
通讯作者:郑锐E-mail:zhengr@sj-hospital.org
作者简介:刘佳明(1987-),女,医师,硕士.



关键词: 肺血栓栓塞, YEARS法, PEGeD法, WELLS评分, D-二聚体
Abstract: Objective To evaluate the diagnostic value of the pulmonary embolism graduated D-dimer (PEGeD) and YEARS algorithms for acute pulmonary embolism. Methods Data on disease history,clinical manifestations,and auxiliary examinations of 454 patients with suspected pulmonary embolism were collected. All patients were assessed using the Standard,PEGeD,and YEARS algorithms. Computed tomography pulmonary angiography was considered as the gold standard for acute pulmonary embolism diagnosis. The sensitivity and specificity of the three algorithms in diagnosing pulmonary embolism were calculated and compared. The receiver operating characteristic curves were then constructed,and the area under the curves (AUCs) were calculated and compared. Results The sensitivity and specificity of the Standard algorithm,the YEARS algorithm,and the PEGeD algorithm were 95.28% and 37.65%,82.76% and 52.16%,and 90.76% and 64.50%,respectively. The AUC of the Standard,YEARS,and PEGeD algorithms was 0.665 (95% CI:0.620-0.709),0.672 (95% CI:0.627-0.715),and 0.776 (95% CI:0.735-0.814),respectively. The AUC of the PEGeD algorithm was larger than that of the Standard and YEARS algorithms,and the difference was statistically significant (P < 0.001). Conclusion The diagnostic value of the PEGeD algorithm for pulmonary embolism is superior to that of the Standard and YEARS algorithms.
Key words: pulmonary embolism, YEARS algorithm, pulmonary embolism graduated d-dimer algorithm, WELLS score, D-dimer
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