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这个病人有深静脉血栓症吗?
Philip S Wells1, Carolyn Owen, Steve Doucette
1Department of Medicine, University of Ottawa, Ontario. pwells@ohri.ca
JAMA
|January 13, 2006
概括
临床预测规则可以改善深静脉血栓症 (DVT) 的诊断. 对于低概率的患者,负的D-二次测试可以排除DVT,避免进一步的成像.
科学领域:
- 医学诊断 医学诊断 医学诊断
- 临床流行病学 临床流行病学
- 血栓形成的研究研究
背景情况:
- 门诊患者怀疑深静脉血栓 (DVT) 存在非特异性症状,增加了错过诊断和致命肺栓塞的风险.
- 鉴于DVT在这个人群中的潜在患病率,选择性和有效的诊断过程至关重要.
研究的目的:
- 系统地审查评估DVT患病率的研究,使用临床预测规则,使用或不使用D-二次测试.
- 评估D-二聚体测试在不同临床概率层对DVT的诊断准确性.
主要方法:
- 1990年至2004年英语和法语研究的系统审查,包括涉嫌DVT的门诊患者的潜在招生.
- 在D-二分体测试或成像之前应用临床预测规则,至少对患者进行3个月的随访.
- 通过临床概率 (低,中等,高) 分析D-二次体的DVT流行率,敏感性,特异性和概率比率 (LRs) 的数据抽象和聚合.
主要成果:
- 14项研究 (超过8000名患者) 使用了临床预测规则;11项纳入了D-二次体测试.
- 患有DVT的概率为5.0% (低),17% (中等) 和53% (高) 的概率组;整体患病率为19%.
- D-二分体测试显示,概率组的敏感性和特异性各不相同,负LRs一般较低,特别是在低概率患者 (0.18%) 中.
结论:
- 在诊断测试之前估计临床概率可以提高DVT诊断的准确性.
- 在低概率的患者中 (DVT患病率<5%),负的D-二次体结果可以可靠地排除DVT,可能避免超声波.
- 对于具有高度临床怀疑的患者,由于特异性较低,D-二次体结果不应仅仅指导临床决策.
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