Clinical Value Of Plasma D-dimer、Ultrasonography And Electrocardiography In Diagnosis Of Acute Pulmonary Embolism

Objective: To investigate the clinical value of plasma D-dimer,echocardiography and electrocardiogram on the diagnosis of acute pulmonary embolism.Methods: To select 167 patients with suspected diagnosis of acute pulmonary embolism from 2015-3 to 2016-11 in the first people’s hospital of jining.According to the result of CTPA,the patients were divided into pulmonary embolism group(76 cases)and non-pulmonary embolism group(91 cases).According to the Wells rating scale score,patients can be divided into high possible group,medium possible group and low possible group.Analysis of demographic characteristics(age,gender),Wells score,plasma D-dimer,echocardiography and electrocardiogram data.Data processing using SPSS17.0 software,counting card information used the chi-square test,the measurement data used variance and t test.Multivariate logistic regression analysis was applied to determine independent risk factors of APE.The receiver operating characteristic curve were Made,the roc area,sensitivity,specificity,diagnostic odds ratio,Youden’s index,positive likelihood ratio,negative likelihood ratio,positive predictive value and negative predictive value of All test were calculated..Results: 1,There were no significant differences between the PE group and the non-PE group in gender,age.There was significant difference of Wells score,plasma D-dimer,echocardiography and electrocardiogram between PE group and non-PE group.The correlations between APE and the Wells score,plasma D-dimer,echocardiography and electrocardiogram are significant.2,According to the Wells rating scale score,patients can be divided into high possible group,medium possible group and low possible group,Each diagnosis rate was 16.7%(8/48),52.2%(48/92),74.1%(20/27),The rate of APE increased with the increase of scores.3,Identification of APE by plasma D-dimmer was:sensitivity of 92.11%,specificity69.23%,diagnostic odds ratio 26.25,Youden’s index 0.61,positive likelihood ratio 2.99,negative likelihood ratio 0.11,positive predictive value 71.43% and negative predictive value91.30%.4,Wells score,plasma D-dimer and the joint of ROC area respectively was 0.821(95%CI: 0.756~0.885),0.807(95% CI: 0.738~0.875),0.907(95% CI: 0.859~0.956).5,Identification of APE by echocardiography was:sensitivity of 85.53%,specificity69.23%,diagnostic odds ratio 13.30,Youden’s index 0.55,positive likelihood ratio 2.78,negative likelihood ratio 0.21,positive predictive value 69.89% and negative predictive value85.14%.6,Identification of APE by electrocardiogram was:sensitivity of 92.11%,specificity54.95%,diagnostic odds ratio 14.23,Youden’s index 0.47,positive likelihood ratio 2.04,negative likelihood ratio 0.14,positive predictive value 63.06% and negative predictive value89.29%.7,Identification of APE by plasma D-dimmer combined echocardiography was:sensitivity of 95.38%,specificity 80.70%,diagnostic odds ratio 86.42,Youden’s index0.76,positive likelihood ratio 49.42,negative likelihood ratio 0.06,positive predictive value84.93% and negative predictive value 93.88%.Plasma D-dimer,echocardiography and the joint of ROC area respectively was 0.807(95% CI: 0.738~0.875),0.774(95% CI:0.701~0.847),0.883(95% CI: 0.829~0.937).8,Identification of APE by plasma D-dimmer combined electrocardiogram was:sensitivity of 95.71%,specificity 73.47%,diagnostic odds ratio 61.85,Youden’s index0.69,positive likelihood ratio 3.61,negative likelihood ratio 0.06,positive predictive value83.75% and negative predictive value 92.31%.Plasma D-dimer,electrocardiogram and the joint of ROC area respectively was 0.807(95% CI: 0.738~0.875),0.735(95% CI:0.659~0.811),0.873(95% CI: 0.816~0.931).9,Identification of APE by echocardiography combined electrocardiogram was:sensitivity of 95.38%,specificity 71.15%,diagnostic odds ratio 50.98,Youden’s index0.67,positive likelihood ratio 3.31,negative likelihood ratio 0.06,positive predictive value80.52% and negative predictive value 92.5%.Echocardiography,electrocardiogram and the joint of ROC area respectively was 0.774(95% CI: 0.701~0.847),0.735(95% CI:0.659~0.811),0.845(95% CI: 0.783~0.906).10,Identification of APE by plasma D-dimmer,echocardiography combined electrocardiogram was:sensitivity of 96.77%,specificity 85.29%,diagnostic odds ratio 174,Youden’s index 0.82,positive likelihood ratio 6.58,negative likelihood ratio 0.04,positive predictive value 92.31% and negative predictive value 93.55%.Plasma D-dimmer,echocardiography combined electrocardiogram of ROC area was 0.914(95% CI:0.867~0.962),Greater than the single one or two of the ROC area.Conclusion:1,Wells score,plasma D-dimer,echocardiography and electrocardiogram Were of great significance in diagnosing APE.2,Wells score combined with plasma D-dimer diagnosis of APE is more effective than either alone.3,Plasma D-dimer combined with echocardiography diagnosis of APE is more effective than either alone.4,Plasma D-dimer combined with ECG diagnosis of APE is more effective than either alone.5,Echocardiography combined with ECG diagnosis of APE is more effective than either alone.6,Plasma D-dimer combined with echocardiography,ECG diagnosis of APE is more effective than either alone.