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目的:探讨心电图(ECG)和21-Daniel ECG评分在肺血栓栓塞症(PTE)危险分层评估中的应用价值。方法:选择2005-01-2009-07南京医科大学第一附属医院收治的251例确诊的PTE患者。根据PTE的危险分层标准分为高危、中危、低危3组。分析251例患者入院48h内的标准12导联ECG,按照Daniel ECG评分系统计算得分。考察3组间ECG波形改变及Daniel ECG评分的差异,并使用ROC曲线评估Daniel ECG分值预测高危PTE、中高危PTE的准确性。结果:251例PTE患者中ECG出现异常者占82.9%,其中最多见为胸前导联T波倒置。Daniel ECG评分中位数为3分。与低危组相比,高危组与中危组PTE的ECG评分均显著增高。在ROC曲线分析中,Daniel ECG分值预测高危PTE和中高危PTE的准确性的曲线下面积分别为0.721和0.837。取Daniel ECG分值为3.5分时,预测高危PTE的灵敏度、特异度、阳性预测值、阴性预测值分别为68.6%、62%、19.4%、92.9%;预测中高危PTE的灵敏度、特异度、阳性预测值、阴性预测值分别为69%、86.1%、74.1%、76.8%。结论:Daniel ECG评分对中高危PTE有较好的预测价值;Daniel ECG分值<3.5分时对高危PTE有较高的排除诊断价值。
Objective: To investigate the value of electrocardiogram (ECG) and 21-Daniel ECG in the assessment of risk stratification of pulmonary thromboembolism (PTE). Methods: A total of 251 confirmed cases of PTE admitted to the First Affiliated Hospital of Nanjing Medical University from January 2005 to July 2007 were selected. According to the risk stratification criteria of PTE, it is divided into three groups: high-risk, medium-risk and low-risk. The standard 12-lead ECG of 251 patients admitted within 48 hours of admission was analyzed and scores were calculated according to the Daniel ECG scoring system. The differences of ECG waveform changes and Daniel ECG scores among the three groups were investigated. The accuracy of the Daniel ECG score in predicting high-risk PTE and middle-high risk PTE was evaluated using ROC curve. Results: Of the 251 patients with PTE, abnormal ECG was found in 82.9% of the patients, the most common of which was T wave inversion in the chest lead. Daniel ECG score of 3 points. Compared with the low-risk group, ECG scores of PTE in high-risk group and intermediate-risk group were significantly higher. In the ROC curve analysis, the area under the curve of Daniel ECG score predicting the accuracy of high-risk PTE and mid-high risk PTE were 0.721 and 0.837, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of predicting high-risk PTE were 68.6%, 62%, 19.4% and 92.9% respectively when the Daniel ECG score was 3.5; predicting the sensitivity, specificity, The positive predictive value and negative predictive value were 69%, 86.1%, 74.1%, 76.8% respectively. Conclusion: The Daniel ECG score has a good predictive value for mid-high risk PTE. The Daniel ECG score <3.5 fps has high diagnostic value for high-risk PTE.