Objective: To evaluate the predictive value of Wells score, revised Geneva score combined with D-dimer for the risk of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: In this study, 234 AECOPD patients underwent CT pulmonary angiography from March 1, 2013 to December 31, 2015 in the First Affiliated Hospital of Zhengzhou University. The basic data of the patients were collected and the patients were classified into AECOPD combined with pulmonary embolism group(pulmonary embolism group) and AECOPD group according to CT pulmonary angiography results. All patients were scored by Wells score and revised Geneva score. The receiver operating characteristic (ROC) curves were generated and the Z test was applied to evaluate the predictive value by comparing the area under the ROC curves (AUC). Results: Totally 32(13.7%) patients had pulmonary embolism out of the 234 AECOPD patients. The AUC by Wells score, revised Geneva score, D-dimer, Wells score + D-dimer, revised Geneva score + D-dimer were 0.869 (95% CI: 0.789-0.949), 0.710 (95% CI: 0.588-0.832), 0.866 (95% CI: 0.790-0.941), 0.926 (95% CI: 0.874-0.977), 0.855 (95% CI: 0.751-0.959). The AUC of Wells score and D-dimer were significantly greater than that of revised Geneva score (Z=2.14, 2.12, both P<0.05); the AUC of Wells score + D-dimer was significantly greater than revised Geneva score + D-dimer (Z=2.73, P<0.05). Conclusion: The predictive value of Wells score + D-dimer for pulmonary embolism in AECOPD patients is higher than revised Geneva score + D-dimer.
目的： 评估Wells评分、修正Geneva评分联合D－二聚体对慢性阻塞性肺疾病(简称慢阻肺)急性加重(AECOPD)合并肺栓塞风险的预测价值。方法： 研究对象为郑州大学第一附属医院2013年3月1日至2015年12月31日因AECOPD入院且均行CT肺动脉造影的234例患者。收集患者的临床资料，根据CT肺动脉造影结果分为AECOPD合并肺栓塞组和单纯AECOPD组。对所有患者行Wells评分评分和修正Geneva评分，制作受试者工作特征(ROC)曲线，应用Z检验对ROC曲线下面积(AUC)进行比较，评价其预测价值。结果： 234例AECOPD患者中合并肺栓塞组32例(13.7%)，单纯AECOPD组202例(86.3%)。Wells评分、修正Geneva评分、D－二聚体、Wells评分＋D－二聚体、修正Geneva评分＋D－二聚体的AUC分别为0.869(95%CI：0.789～0.949)、0.710(95%CI：0.588～0.832)、0.866(95%CI：0.790～0.941)、0.926(95%CI：0.874～0.977)、0.855(95%CI：0.751～0.959)。Wells评分、D－二聚体的AUC均显著大于修正Geneva评分(Z＝2.14、2.12，均P<0.05)；Wells评分＋D－二聚体的AUC显著大于修正Geneva评分＋D－二聚体(Z＝2.73，P<0.05)。结论： Wells评分＋D－二聚体对AECOPD合并肺栓塞的预测价值比修正Geneva评分＋D－二聚体高。.
Keywords: Chronic Obstructive Pulmonary Disease; D-dimer; Pulmonary Embolism; Revised Geneva score; Wells score.