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目的探讨CHA2DS2-VASc评分量表对内科患者急性肺栓塞(acute pulmonary embolism,APE)诊断的预测价值。方法选取2013年1月至2015年12月高度疑诊的APE患者共42例进行回顾性分析,收集患者基本资料。以CT肺动脉造影(CT pulmonary angiogram,CTPA)作为诊断金标准分组,分别用CHA2DS2-VASc评分量表和简化版Wells量表评估病情,计算CHA2DS2-VASc评分各界值的诊断价值。绘制ROC曲线评价两种评分对APE的预测价值,并利用约登指数筛选最佳截断值。结果 42例患者中确诊APE29例,排除13例。两组之间既往脑卒中史、CHADS2-VASc评分和简化版Wells评分差异均有统计学意义(P<0.05)。CHADS2-VASc评分值越高,APE的可能性越大。CHADS2-VASc量表的ROC曲线下面积(AUC)为0.715±0.088,最佳截断点为4.5分,灵敏度58.6%,特异度84.6%;简化版Wells量表的AUC为0.841±0.062,最佳截断值为1.5分,灵敏度62.1%,特异度92.3%。两者比较差异无统计学意义(P>0.05)。结论 CHA2DS2-VASc评分量表对内科患者APE的发生有较高的预测价值。
Objective To investigate the predictive value of CHA2DS2-VASc in the diagnosis of acute pulmonary embolism (APE) in medical patients. Methods Forty-two patients with highly suspected APE from January 2013 to December 2015 were retrospectively analyzed and their basic data were collected. The diagnostic value of the CHA2DS2-VASc score was calculated by using the CT pulmonary angiogram (CTPA) as the gold standard for diagnosis. The CHA2DS2-VASc score scale and the simplified Wells scale were used to evaluate the disease. The ROC curve was drawn to evaluate the predictive value of the two scores on APE and the optimal cutoff value was screened using the Youden index. Results Forty-two patients were diagnosed with APE in 29 cases and 13 cases were excluded. Past history of stroke, CHADS2-VASc score and simplified Wells score were significantly different between the two groups (P <0.05). The higher the CHADS2-VASc score, the greater the likelihood of APE. The area under the ROC curve (AUC) of the CHADS2-VASc scale was 0.715 ± 0.088, the best cutoff point was 4.5, the sensitivity was 58.6% and the specificity was 84.6%. The AUC of the simplified Wells scale was 0.841 ± 0.062 and the best cutoff Value of 1.5 points, the sensitivity of 62.1%, specificity of 92.3%. There was no significant difference between the two (P> 0.05). Conclusion The CHA2DS2-VASc scale has a high predictive value for the occurrence of APE in medical patients.