Chinese General Practice ›› 2024, Vol. 27 ›› Issue (09): 1062-1067.DOI: 10.12114/j.issn.1007-9572.2023.0511
• Original Research • Previous Articles Next Articles
Received:
2023-08-16
Revised:
2023-10-14
Published:
2024-03-20
Online:
2023-12-19
Contact:
HUANG Yi
通讯作者:
黄毅
作者简介:
基金资助:
项目 | 诊断标准 | 积分(分) |
---|---|---|
4PEPS | 年龄 | |
<50岁 | -2 | |
50~64岁 | -1 | |
≥65岁 | 0 | |
慢性呼吸道疾病 | -1 | |
心率<80次/min | -1 | |
胸痛和急性呼吸困难 | 1 | |
男性 | 2 | |
激素治疗 | 2 | |
静脉血栓栓塞史 | 2 | |
晕厥 | 2 | |
4周内制动史 | 2 | |
血氧饱和度<95% | 3 | |
小腿疼痛和/或单侧下肢水肿 | 3 | |
PE为最可能的诊断 | 5 | |
临床概率 | 非常低的临床预测概率:可直接排除PE | <0 |
低临床预测概率:如果D-二聚体<1 000 ng/mL,则可以排除PE | 0~5 | |
中度临床预测概率:如果患者<50岁且D-二聚体<500 ng/mL或患者年龄≥50岁且D-二聚体<年龄×10 ng/mL,则可以排除PE | 6~12 | |
高临床预测概率:没有影像学检查不能排除PE | ≥13 |
Table 1 4PEPS standard
项目 | 诊断标准 | 积分(分) |
---|---|---|
4PEPS | 年龄 | |
<50岁 | -2 | |
50~64岁 | -1 | |
≥65岁 | 0 | |
慢性呼吸道疾病 | -1 | |
心率<80次/min | -1 | |
胸痛和急性呼吸困难 | 1 | |
男性 | 2 | |
激素治疗 | 2 | |
静脉血栓栓塞史 | 2 | |
晕厥 | 2 | |
4周内制动史 | 2 | |
血氧饱和度<95% | 3 | |
小腿疼痛和/或单侧下肢水肿 | 3 | |
PE为最可能的诊断 | 5 | |
临床概率 | 非常低的临床预测概率:可直接排除PE | <0 |
低临床预测概率:如果D-二聚体<1 000 ng/mL,则可以排除PE | 0~5 | |
中度临床预测概率:如果患者<50岁且D-二聚体<500 ng/mL或患者年龄≥50岁且D-二聚体<年龄×10 ng/mL,则可以排除PE | 6~12 | |
高临床预测概率:没有影像学检查不能排除PE | ≥13 |
项目 | 评分标准 | 得分(分) |
---|---|---|
Wells评分法 | 既往DVT或PE病史 | 1.5 |
4周内手术或制动史 | 1.5 | |
肿瘤 | 1 | |
咯血 | 1 | |
心率>100次/min | 1.5 | |
深静脉血栓的临床征象 | 3 | |
其他临床诊断的倾向性<PE | 3 | |
临床可能性 | 三分法 | |
低度风险 | <2 | |
中度风险 | 2~6 | |
高度风险 | >6 | |
二分法 | ||
PE不可能 | ≤4 | |
PE可能 | >4 |
Table 2 Wells score
项目 | 评分标准 | 得分(分) |
---|---|---|
Wells评分法 | 既往DVT或PE病史 | 1.5 |
4周内手术或制动史 | 1.5 | |
肿瘤 | 1 | |
咯血 | 1 | |
心率>100次/min | 1.5 | |
深静脉血栓的临床征象 | 3 | |
其他临床诊断的倾向性<PE | 3 | |
临床可能性 | 三分法 | |
低度风险 | <2 | |
中度风险 | 2~6 | |
高度风险 | >6 | |
二分法 | ||
PE不可能 | ≤4 | |
PE可能 | >4 |
组别 | 例数 | 性别[例(%)] | 年龄[M(P25,P75),岁] | |
---|---|---|---|---|
男 | 女 | |||
APE组 | 323 | 158(48.9) | 165(51.1) | 73(68,80) |
非APE组 | 870 | 450(51.7) | 420(48.3) | 75(68,81) |
χ2(Z)值 | 0.743 | -1.172a | ||
P值 | 0.389 | 0.241 |
Table 3 Comparison of general data of the APE and non-APE groups
组别 | 例数 | 性别[例(%)] | 年龄[M(P25,P75),岁] | |
---|---|---|---|---|
男 | 女 | |||
APE组 | 323 | 158(48.9) | 165(51.1) | 73(68,80) |
非APE组 | 870 | 450(51.7) | 420(48.3) | 75(68,81) |
χ2(Z)值 | 0.743 | -1.172a | ||
P值 | 0.389 | 0.241 |
组别 | 例数 | 4PEPS | AADD算法 | Standard算法 | YEARS算法 | PEGeD算法 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
阳性 | 阴性 | 合计 | 阳性 | 阴性 | 合计 | 阳性 | 阴性 | 合计 | 阳性 | 阴性 | 合计 | 阳性 | 阴性 | 合计 | ||
APE组 | 323 | 307 | 16 | 323 | 316 | 7 | 323 | 319 | 4 | 323 | 314 | 9 | 323 | 316 | 7 | 323 |
非APE组 | 870 | 593 | 277 | 870 | 712 | 158 | 870 | 758 | 112 | 870 | 675 | 195 | 870 | 675 | 195 | 870 |
合计 | 900 | 293 | 1 193 | 1 028 | 165 | 1 193 | 1 077 | 116 | 1 193 | 989 | 204 | 1 193 | 991 | 202 | 1 193 |
Table 4 Prediction results of five prediction methods for APE in the elderly
组别 | 例数 | 4PEPS | AADD算法 | Standard算法 | YEARS算法 | PEGeD算法 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
阳性 | 阴性 | 合计 | 阳性 | 阴性 | 合计 | 阳性 | 阴性 | 合计 | 阳性 | 阴性 | 合计 | 阳性 | 阴性 | 合计 | ||
APE组 | 323 | 307 | 16 | 323 | 316 | 7 | 323 | 319 | 4 | 323 | 314 | 9 | 323 | 316 | 7 | 323 |
非APE组 | 870 | 593 | 277 | 870 | 712 | 158 | 870 | 758 | 112 | 870 | 675 | 195 | 870 | 675 | 195 | 870 |
合计 | 900 | 293 | 1 193 | 1 028 | 165 | 1 193 | 1 077 | 116 | 1 193 | 989 | 204 | 1 193 | 991 | 202 | 1 193 |
算法 | 灵敏度(%) | 特异度(%) | 误诊率(%) | 漏诊率(%) | 阳性预测值(%) | 阴性预测值(%) | 阳性似然比 | 阴性似然比 | 正确率(%) | 比数积 | Youden指数 |
---|---|---|---|---|---|---|---|---|---|---|---|
4PEPS | 95.05 | 31.84 | 68.16 | 4.95 | 34.11 | 94.54 | 1.39 | 0.16 | 48.95 | 8.96 | 0.27 |
AADD算法 | 97.83 | 18.16 | 81.84 | 2.17 | 30.74 | 95.76 | 1.20 | 0.12 | 39.73 | 10.02 | 0.16 |
Standard算法 | 98.76 | 12.87 | 87.13 | 1.24 | 29.62 | 96.55 | 1.13 | 0.10 | 36.13 | 11.78 | 0.12 |
YEARS算法 | 97.21 | 22.41 | 77.59 | 2.79 | 31.75 | 95.59 | 1.25 | 0.12 | 42.67 | 10.08 | 0.20 |
PEGeD算法 | 97.83 | 22.41 | 77.59 | 2.17 | 31.89 | 96.53 | 1.26 | 0.10 | 42.83 | 13.04 | 0.20 |
Table 5 Predictive efficacy of the five prediction methods for APE in the elderly
算法 | 灵敏度(%) | 特异度(%) | 误诊率(%) | 漏诊率(%) | 阳性预测值(%) | 阴性预测值(%) | 阳性似然比 | 阴性似然比 | 正确率(%) | 比数积 | Youden指数 |
---|---|---|---|---|---|---|---|---|---|---|---|
4PEPS | 95.05 | 31.84 | 68.16 | 4.95 | 34.11 | 94.54 | 1.39 | 0.16 | 48.95 | 8.96 | 0.27 |
AADD算法 | 97.83 | 18.16 | 81.84 | 2.17 | 30.74 | 95.76 | 1.20 | 0.12 | 39.73 | 10.02 | 0.16 |
Standard算法 | 98.76 | 12.87 | 87.13 | 1.24 | 29.62 | 96.55 | 1.13 | 0.10 | 36.13 | 11.78 | 0.12 |
YEARS算法 | 97.21 | 22.41 | 77.59 | 2.79 | 31.75 | 95.59 | 1.25 | 0.12 | 42.67 | 10.08 | 0.20 |
PEGeD算法 | 97.83 | 22.41 | 77.59 | 2.17 | 31.89 | 96.53 | 1.26 | 0.10 | 42.83 | 13.04 | 0.20 |
项目 | NRI | Z值 | P值 |
---|---|---|---|
AADD算法 | 1 | ||
4PEPS | 0.218 | 2.364a | 0.018 |
Standard算法 | -0.087 | -0.946a | 0.346 |
YEARS算法 | 0.073 | 0.789a | 0.434 |
PEGeD算法 | 0.085 | 0.923a | 0.356 |
Table 6 Comparison of the predictive value of five prediction methods for APE in the elderly
项目 | NRI | Z值 | P值 |
---|---|---|---|
AADD算法 | 1 | ||
4PEPS | 0.218 | 2.364a | 0.018 |
Standard算法 | -0.087 | -0.946a | 0.346 |
YEARS算法 | 0.073 | 0.789a | 0.434 |
PEGeD算法 | 0.085 | 0.923a | 0.356 |
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