Wells量表和修正Geneva量表及其简化版对肺栓塞临床可能性评估的应用

doi:10.16150/j.1671-2870.2017.04.014

摘要/Abstract

摘要： 目的: 回顾性分析肺动脉栓塞（pulmonary embolism,PE）患者确诊前的临床资料,探讨临床评估量表在PE诊断中的应用价值。方法: 纳入上海交通大学医学院附属瑞金医院呼吸科2011年6月至2016年6月及瑞金北院呼吸科2012年12月至2016年6月确诊的PE患者共78例,回顾性分析其临床资料,用Wells量表和修正Geneva量表及各自简化量表分别对患者进行临床评估,并分析、比较其诊断PE的价值。结果: ①用Wells量表对患者进行评分,其中低度PE可能性者为12例（15.38%）,中度PE可能性者55例（70.51%）,高度PE可能性者11例（14.10%）;②用修正Geneva量表进行评估,低度PE可能性者为16例（20.52%）,中度PE可能性者55例（70.51%）,高度PE可能性者7例（8.98%）;③用简化Wells量表进行评估,PE不可能组为26例（33.33%）,PE可能组为52例（66.67%）;④用简化Geneva量表二分类评分,PE不可能组为43例（55.13%）,PE可能组为35例（44.87%）;用简化Geneva量表三分类评分,低度PE可能性者为15例（19.23%）,中度PE可能性者58例（74.36%）,高度PE可能性者5例（1.28%）;⑤Wells量表与修正Geneva量表两者分值大部分都集中于中度和高度PE可能性分值区域,其比例分别为84.61%和79.49%,两者间差异无统计学意义（ P=0.482）;⑥Wells量表和简化Wells量表诊断78例PE患者的灵敏度分别为84.61%和66.67%,差异有统计学意义（P<0.01）。78例确诊PE的患者中,经简化Wells量表和简化Geneva量表（二分类、三分类）评估为PE的比例分别为66.67%、44.87%和75.64%,其中,简化Geneva量表二分类与简化Wells量表、简化Geneva三分类评估法间差异均有统计学意义（P<0.01）。结论: 在对PE临床可能性的评估中,Wells量表、修正Geneva量表及其简化量表预测风险评分越高,则诊断PE的灵敏度越高。Wells量表和修正Geneva量表评估PE的价值相似,而简化Geneva量表三分类法较二分类、简化Wells量表更能提高临床医师对PE的警惕性,降低漏诊率。

关键词: 肺栓塞, Wells量表, 修正Geneva量表, 简化Wells量表, 简化Geneva量表

Abstract: Objective: To analyze the clinical data of pulmonary embolism(PE) patients retrospectively for evaluating the performance of clinical scores(Wellsscore, revised Geneva scoreand their simplified versions) in assessing the probabi-lity of PE. Methods: A total of 78 patients diagnosed as PE and received treatment were recruited at Ruijin Hospital from June 2011 to June 2016 and at Ruijin Hospital North Branch from December 2012 to June 2016. All the patients were assessed by Wells score, revised Geneva score and simplified Wells score and simplified revised Geneva score, respectively. The performance of these scores were analyzed and compared. Results: For Wells score,15.38% patients had low clinical probability, 70.51% patients had moderate clinical probability and 14.10% patients had high clinical probability. By revised Geneva score, the percentages of low, moderate and high clinical probability were 20.52%, 70.51% and 8.98%, respectively. Bysimplified Wells score, the percentages of PE unlikely and PE likely were 33.33% and 66.67%, respectively. By simplifiedrevised Geneva score, the percentages of PE unlikely and PE likely were 55.13% and 44.87%, respectively; and the percentages of low, moderate and high probability were 19.23%, 74.36% and 1.28%, respectively, when the three levels scoring was used. Most patients had moderate or high clinical probability of PE when assessed by Wells score and revised Geneva score, with a percentage of moderate or high clinical probability of 84.61% and 79.49%, respectively; there was no significant difference in performance between Wells score and revised Geneva score (P=0.482). Among these 78 patients, the sensitivity of Wells score and simplified Wells score for PE were 84.61% and 66.67%, respectively(P<; 0.01). The percentages of PE patients diagnosed by simplified Wells score, simplified revised Geneva score-two levels scoring and simplified revised Geneva score-three levels scoring were 66.67%, 44.87% and 75.64%, respectively. The difference between the simplified revised Geneva score-two levels scoring and simplified revised Geneva score-three levels scoring was statistically significant(P<; 0.01). Significant difference was also found between simplified Wells score and simplified revised Geneva score-two levels scoring. Conclusions: For assessing the clinical probability of PE, the higher the clinical score, the higher the sensitivity of Wells score, revised Geneva score and simplified Wells score for diagnosing PE is. The Wells score has similar performance with revised Geneva score in diagnosing PE. Compared with simplified Geneva score-two level and simplied Wells score, Simplified revised Geneva score-three levels scoring could improve the vigilance of PE and decrease the rate of missed diagnosis.

Key words: Pulmonary embolism, Wells score, Revised Geneva score, Simplified Wells score, Simplified Geneva score

中图分类号:

R563.5

晁慧娟, 陈长强, 陈聆, 程齐俭. Wells量表和修正Geneva量表及其简化版对肺栓塞临床可能性评估的应用[J]. 诊断学理论与实践, 2017, 16(04): 414-418.

CHAO Huijuan, CHENG Changqiang, CHEN Ling, CHENGQijian. Application of Wells score, revised Geneva score, simplified Wells and revised Geneva score for assessing clinical probability of pulmonary embolism[J]. Journal of Diagnostics Concepts & Practice, 2017, 16(04): 414-418.

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