Wells评分联合D-二聚体检测在深静脉血栓诊断中的应用

doi:10.3969/j.issn.1673-8640.2016.07.008

检验医学 ›› 2016, Vol. 31 ›› Issue (7): 581-583.DOI: 10.3969/j.issn.1673-8640.2016.07.008

Wells评分联合D-二聚体检测在深静脉血栓诊断中的应用

段秀群, 尹良琼, 龚国富

鄂州市中心医院,湖北鄂州 436000

收稿日期:2015-07-04 出版日期:2016-07-30 发布日期:2016-08-10
作者简介:null
作者简介：段秀群,女,1976年生,学士,副主任技师,主要从事血栓和止血研究。

通讯作者：龚国富, 联系电话：0711-3222284。

Wells' score combined with D-dimer determination for screening deep vein thrombosis

DUAN Xiuqun, YIN Liangqiong, GONG Guofu

Ezhou Central Hospital,Ezhou 436000,Hubei,China

Received:2015-07-04 Online:2016-07-30 Published:2016-08-10

摘要/Abstract

摘要： 目的

探讨深静脉血栓（DVT）形成的临床概率模型Wells评分联合D-二聚体（DD）测定在筛查DVT中的临床应用价值。

方法

对127例疑似DVT患者进行Wells评分,得出预测概率得分,同时测定其治疗前DD水平,最后根据彩色多普勒超声及多层螺旋CT静脉造影术明确诊断。

结果

Wells评分筛查DVT的阳性率为30.7%,DD筛查DVT的阳性率为36.2%,两者联合筛查DVT的阳性率为47.2%,联合筛查的阳性率明显高于Wells评分和DD单项筛查（P<0.05）。DD筛查的性能优于Wells评分（P<0.05）。

结论

Wells评分联合DD检测可辅助早期筛查DVT,降低DVT漏诊率,并有效排除DVT。

关键词: D-二聚体, Wells评分, 深静脉血栓

Abstract:

Objective To investigate the significance of clinical probability model Wells' score combined with D-dimer（DD）determination for screening deep vein thrombosis（DVT）. Methods A total of 127 patients with suspected DVT were enrolled for Wells' score,and the prediction probability score was obtained. DD level before treatment was determined. According to the color Doppler flow imaging and multislice CT venography,the further diagnosis was performed. Results The positive rate of Wells' score for screening DVT was 30.7%,and the positive rate of DD determination was 36.2%. The positive rate of combined determination for screening DVT was 47.2%,which was higher than those of Wells' score and DD determination（P<0.05）. The performance of DD determination was better than that of Wells' score（P<0.05）. Conclusions Wells' score combined with DD determination can help for the early screening of DVT,reduce miss diagnosis rate,and effectively eliminate DVT.

Key words: D-dimer, Wells' score, Deep vein thrombosis

中图分类号:

R446.11

段秀群, 尹良琼, 龚国富. Wells评分联合D-二聚体检测在深静脉血栓诊断中的应用[J]. 检验医学, 2016, 31(7): 581-583.

DUAN Xiuqun, YIN Liangqiong, GONG Guofu. Wells' score combined with D-dimer determination for screening deep vein thrombosis[J]. Laboratory Medicine, 2016, 31(7): 581-583.

图/表 1

参考文献 14

1	焦春莲,曹向黎,杨红平,等. 脊柱结核术后未愈及复发危险因素的护理干预[J]. 中国煤炭工业医学杂志,2012,15(1):134-136.
2	时启标,孙东立,赵敏. 肺栓塞急诊救治研究新进展[J]. 中国急救医学,2002,22(5):308-311.
3	刘红军. D-二聚体检测的临床应用[J]. 检验医学与临床,2011,8(3):382.
4	WELLS PS. Integrated strategies for the diagnosis of venous thromboembolism[J]. J Thromb Haemost,2007,5(Suppl l):41-50.
5	WELLS PS,ANDERSON DR,BORMANIS J,et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management[J]. Lancet,1997,350(9094):1795-1798.
6	SHITRIT D,HEYD J,RAVEH D,et al. Diagnostic value of the D-dimer test in deep vein thrombosis:improved results by a new assay method and by using discriminate levels[J]. Thromb Res,2001,102(2):125-131.
7	WADA H,KOBAYASHI T,ABE Y,et al. Elevated levels of soluble fibrin or D-dimer indicate high risk of thrombosis[J]. J Thromb Haemost,2006,4(6):1253-1258.
8	VOSSEN JA,ALREKTSON J,SENSARMA A,et a1. Clinical usefulness of adjusted D-dimer cut-off values to exclude pulmonary embolism in a community hospital emergency department patient population[J]. Acta Radiol,2012,53(7):765-768.
9	BOUNAMEAUX H,PERRIER A,RIGHINI M,et a1. Diagnosis of venons thromboembolism:an update[J]. Vasc Med,2010,15(5):399-406.
10	HULL RD.Diagnosing pulmonary embolism with improved certainty and simplicity[J]. JAMA,2006,295(2):213-215.
11	MICHIELS JJ,GADISSEUR A,VAN DER PLANKEN M,et al. A critical appraisal of non-invasive diagnosis and exclusion of deep vein thrombosis or pulmomary enbolism in outpatients with suspected deep vein thrombosis or pulmonary embolism in outpatients with suspected deep vein thrombosis or pulmonary embolism:how many tests do we need?[J]. Int Angiol,2005,24(1):27-39.
12	GUYATT GH,NORRIS SL,SCHULMAN S,et al. Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest,2012,141(2 Suppl):53S-70S.
13	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第2版)[J]. 中华外科杂志,2012,50(7):611-614.
14	马育霞,刘毅,王鹏升,等. D二聚体阴性肺栓塞患者32例临床特点分析[J]. 中国综合临床,2014,30(8):831-833.

项目	敏感性	特异性	阳性预测值	阴性预测值	诊断效率
DD	80.3^*	93.4^*	89.1^*	87.7^*	88.2^*
Wells评分	60.1	89.5	79.5	77.2	77.9

项目	敏感性	特异性	阳性预测值	阴性预测值	诊断效率
DD	80.3^*	93.4^*	89.1^*	87.7^*	88.2^*
Wells评分	60.1	89.5	79.5	77.2	77.9

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Wells评分联合D-二聚体检测在深静脉血栓诊断中的应用

Wells' score combined with D-dimer determination for screening deep vein thrombosis

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