中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2017, Vol. 46 ›› Issue (3): 266-269.doi: 10.12007/j.issn.0258-4646.2017.03.019

• 论著 • 上一篇    下一篇

疑诊肺栓塞患者患病风险评估的新模型

赵洋子 1,苏广胜 2,李卉 3,吴曦子 1,曾仁庆 1,李蕙伊 1,刘畅 1,赵丽 4,徐俊杰 5,崇巍 1   

  1. 中国医科大学 1 附属第一医院急诊科,沈阳 110001;2 附属盛京医院心内科,沈阳 110004;3 附属第四医院心内科,沈阳 110032;4 附属第一医院放射科,沈阳 110001;5 附属第一医院检验医学科,卫生部艾滋病免疫学重点实验室,沈阳 110001
  • 收稿日期:2016-09-07 出版日期:2017-03-30 发布日期:2017-01-20
  • 通讯作者: 崇巍 E-mail:chongweixiena@126.com
  • 作者简介:赵洋子(1990 -),女,硕士研究生 .

A New Risk Assessment Model for Suspected Pulmonary Embolism

ZHAO Yangzi1,SU Guangsheng2,LI Hui3,WU Xizi1,ZENG Renqing1,LI Huiyi1,LIU Chang1,ZHAO Li4,XU Junjie5,CHONG Wei1   

  1. 1 Department of Emergency Medicine,The First Hospital,China Medical University,Shenyang 110001,China;2 Departmen of Cardiology,Shengjing Hospital, China Medical University,Shenyang 110004,China;3 Departmen of Cardiology,The Fourth Affiliated Hospital,China Medical University,Shenyang 110032,China;4 Radiology,The First Hospital,China Medical University,Shenyang 110001,China,5 Key Laboratory of AIDS Immunology of Ministry of Health,Department of Laboratory Medicine,The First Hospital,China Medical University,Shenyang 110001,China
  • Received:2016-09-07 Online:2017-03-30 Published:2017-01-20

摘要: 目的 建立新的肺栓塞(PE)患病风险评估模型,提高肺动脉 CTA 的阳性检出率。方法 将研究样本中 PE 患病组和非 患病组组间有统计学差异的变量纳入 logistic 回归分析,构建疑诊 PE 的患病风险评估模型。根据模型求得的每位患者的患病概率,绘制受试者工作(ROC)曲线并确定截断值。另收集验证样本评价该模型的诊断效能。结果 对研究样本的单因素分析 显示,共 17 个变量在患病和非患病 2 组间存在统计学差异。其中不明原因的呼吸困难、整条腿肿胀/凹陷性水肿、D-二聚体和年 龄是患 PE 的独立危险因素。由 ROC 曲线确立模型的截断值为 0.38。验证样本显示,本研究提出的 PE 患病风险评估模型可将 我院肺动脉 CTA 阳性检出率从 27%提高至 54%。结论 新的 PE 患病风险评估模型可提高肺动脉 CTA 的检出率。

关键词: 肺栓塞, 患病风险评估模型, 肺动脉 CTA, D-二聚体

Abstract: Objective To develop a predictive model for pulmonary embolism(PE)based on the related clinical symptoms,signs,and the laboratory index,so as to improve the positive rate of CTPA. Methods The model was developed from a database of 119 patients with suspected PE. The risk factors of suspected PE were analyzed by logistic regression analysis,which included significant differences in the prevalence of PE between non-diseased and non-diseased groups. Receiver operating characteristic(ROC)curves was draw to determine the cut-off value of the clinical probability. It was validated in an independent sample of 106 patients with suspected PE. Results According to the univariate analysis,17 of51 variables show a significant difference between PE and non-PE patients. The model comprised 4 variables:age,dyspnea,D-dimer and unilateral leg swelling. The area under the ROC curve is 0.776,and the cut-off value is supposed to be 0.38. In the validation sample,27% patients had PE confirmed by CTPA. The prevalence of PE was 54% when the clinical probability was above 0.38. Conclusion The proposed predictive model in this study can improve the positive rate of CTPA,simplify the diagnosis process of suspected PE patients.

Key words: pulmonary embolism, prediction model of the clinical probability, computed tomographic pulmonary angiography, D-dimer

中图分类号: 

  • R447
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