缺血修饰白蛋白、D-二聚体联合Wells评分对肺栓塞的诊断价值
The value of the ischemia modified albumin or D-dimer combined with Wells scoring system in the diagnosis of pulmonary embolism
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摘要: 目的：探讨缺血修饰白蛋白（ischemia modified albumin,IMA）、D-二聚体以及Wells临床评分系统对肺栓塞（PE）的诊断价值。方法：收集疑似PE患者共46例，以多层CT肺动脉造影为确诊PE的金标准,检测20例确诊为PE患者（PE组）、26例非PE患者（非PE组）及对照组14名健康受试者血浆缺血修饰白蛋白（IMA）、D-二聚体含量，利用ROC曲线分析并比较IMA、D-二聚体对PE的诊断价值。结果：PE组患者血清IMA和血浆D-二聚体均较非PE组与对照组明显增高（P<0.01）。ROC曲线分析，IMA的最佳界值为63.45 U/mL时，其诊断PE的敏感性、特异性、阳性预测值、阴性预测值分别为90.00%、76.90%、75.00%、90.90%。D-二聚体的最佳界值为0.795 mg/L时，诊断PE的敏感性、特异性、阳性预测值、阴性预测值分别为90.00%、57.70%、66.67%、89.47%。IMA联合Wells评分诊断PE的敏感性、特异性、阳性预测值、阴性预测值分别为99.00%、38.45%、54.89%、98.20%；D-二聚体联合Wells评分诊断PE的敏感性、特异性、阳性预测值、阴性预测值分别为99.00%、28.85%、51.29%、97.45%。结论：血清IMA可用于PE的诊断，其诊断的特异性高于血浆D-二聚体。与Wells评分结合时,血清IMA诊断PE阳性预测值比D-二聚体高，而阴性预测值和敏感性与D-二聚体相似。Abstract: Objective: To investigate the value of the ischemia modified albumin(IMA),D-dimer combined with Wells scoring system in the diagnosis of pulmonary embolism(PE).Methods: Forty-six patients with suspected PE were examinated using multislice CT pulmonary angiography,and 20 PE cases,26 cases non-PE cases and 14 healthy people were divided into the PE group,non-PE group and control group,respectively.The levels of IMA and D-dimer in 3 groups were measured.The diagnostic value of IMA and D-dimer in PE patients were compared with ROC curve.Results: The levels of IMA and D-dimer in PE group were significantly higher than those in non-PE and control groups(P<0.01).The ROC curve showed that the most appropriate cut-off value of IMA was 63.45 U/mL,the sensitivity,specificity,positive predictive value and negative predictive value were 90.00%,76.90%,75.00% and 90.90%,respectively.The ROC curve showed that the most appropriate cut-off value of D-dimer was 0.795 mg/L,the sensitivity,specificity,positive predictive value and negative predictive value were 90.00%, 57.70%, 66.67% and 89.47%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of IMA combined with Wells scoring in diagnosing PE were 99.00%,38.45%,54.89% and 98.20%,respectively,and the sensitivity,specificity,positive predictive value and negative predictive value of D-dimer combined with Wells scoring in diagnosing PE were 99.00%,28.85%,51.29% and 97.45%,respectively.Conclusions: IMA can be used to diagnose PE,the diagnostic specificity of IMA is higher than that of the plasma D-dimer.The positive predictive value of IMA combined with Wells scoring in diagnosing PE is higher than that of D-dimer combined with Wells scoring,but the negative predictive value and sensitivity of the IMA combined with Wells scoring are similar to the D-dimer combined with Wells scoring.
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Key words:
- pulmonary embolism /
- ischemia modified albumin /
- clicial score /
- diagnosis /
- ROC curve
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