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【关键词】 Wells评分法;静脉血栓栓塞症;肺血栓栓塞症;定量预测方法
静脉血栓栓塞症(VTE)包括深静脉血栓(DVT)和肺血栓栓塞症(PTE)。因PTE为肺栓塞(PE)最常见类型，占PE的绝大多数，故通常所称PE即指PTE。在西方国家VTE发病率约1‰～2‰〔1〕。VTE患者漏诊误诊后，可以发生猝死、慢性肺动脉高压等严重并发症，因此VTE的早期正确诊断至关重要。大量研究表明，对疑似VTE的患者进行临床可能性预测已经成为VTE诊断策略的重要基础〔2〕，而目前使用最广泛的临床预测方法就是Wells评分法。Wells评分法包括Wells DVT评分法和Wells PE评分法两部分。现将Wells评分法的产生、组成及应用进展综述如下。
1 Wells DVT评分法
1995年Wells等〔3〕在
2 Qaseem A，Snow V，Barry P,et al.Current diagnosis of venous thromboembolism in primary care：a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians〔J〕.Ann Intern Med，2007;146(6):4548.
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9 Dryjski M，O′BrienIrr MS，Harris LM,et al.Evaluation of a screening protocol to exclude the diagnosis of deep venous thrombosis among emergency department patients〔J〕.J Vasc Surg，2001;34(6):10105.
10 Cornuz J，Ghali WA，Hayoz D，et al.Clinical prediction of deep venous thrombosis using two risk assessment methods in combination with rapid quantitative Ddimer testing〔J〕.Am J Med，2002;112(3):198203.
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12 Anderson DR，Kovacs MJ，Kovacs G,et al.Combined use of clinical assessment and Ddimer to improve the management of patients presenting to the emergency department with suspected deep vein thrombosis(the EDITED study)〔J〕.J Thromb Haemost，2003;1(2):64551.
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15 Oudega R，Hoes AW，Moons KG.The Wells rule does not adequately rule out deep venous thrombosis in primary care patients〔J〕.Ann Intern Med，2005;143:1007.
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17 Wells PS，Ginsberg JS，Anderson DR，et al.Use of a clinical model for the safe management of patients with suspected pulmonary embolism〔J〕. Ann Intern Med，1998;129(2):9971005.
18 Celi A，Palla A，Petruzzelli S,et al.Prospective study of a standardized questionnaire to improve clinical estimate of pulmonary embolism〔J〕. Chest，1989;95(2):3327.
19 Hoellerich VL，Wigton RS.Diagnosing pulmonary embolism using clinical findings〔J〕.Arch Intern Med，1986;146(9):1699704.
20 Wells PS，Anderson DR，Rodger M,et al.Derivation of a simple clinical model to categorize patients probability of pulmonary embolism：increasing the models utility with the SimpliRED Ddimer〔J〕.Thromb Haemost，2000;83(3):41620.
21 Righini M，Le Gal G，Perrier A,et al.Clinical probability assessment of pulmonary embolism by the Wells′ score：is the easiest the best〔J〕? J Thromb Haemost，2006;4(3):7024.
22 Buller HR，Agnelli G，Hull RD,et al.Antithrombotic therapy for venous thromboembolic disease：the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy〔J〕.Chest，2004;126(3):40128.
23 Siragusa S，Malato A，Falaschi F,et al.Deferral of assessment of pulmonary embolism〔J〕.Haematologica，2007;92(3):4103.
24 Rodger MA，Bredeson CN，Jones G,et al.The bedside investigation of pulmonary embolism diagnosis study：a doubleblind randomized controlled trial comparing combinations of 3 bedside tests vs ventilationperfusion scan for the initial investigation of suspected pulmonary embolism〔J〕.Arch Intern Med，2006;166(2):1817.
25 Van Belle A,Büller HR,Huisman MY,et al.Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability，Ddimer testing，and computed tomography〔J〕.JAMA，2006;295(2):1729.
26 Wicki J，Perneger TV，Junod AF,et al.Assessing clinical probability of pulmonary embolism in the emergency ward：a simple score〔J〕.Arch Intern Med，2001;161(1)：927.
27 Le Gal G，Righini M，Roy PM,et al.Prediction of pulmonary embolism in the emergency department：the revised Geneva score〔J〕.Ann Intern Med，2006;144(3):16571.
28 Miniati M，Monti S，Bottai M.A structured clinical model for predicting the probability of pulmonary embolism〔J〕.Am J Med，2003;114(3):1739.
29 Stllberger C，Finsterer J，Lutz W,et al.Multivariate analysesbased prediction rule for pulmonary embolism〔J〕.Thromb Res，2000;97(5):26773.
30 Moores LK，Collen J F，Woods KM,et al.Practical utility of clinical prediction rules for suspected acute pulmonary embolism in a large academic institution〔J〕.Thromb Res，2004;113(1)：16.
31 Ollenberger GP，Worsley DF.Effect of patient location on the performance of clinical models to predict pulmonary embolism〔J〕.Thromb Res，2006;118(6):68590.
32 Tamariz LJ，Eng J，Segal JB,et al.Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism：a systematic review〔J〕. Am J Med，2004;117(9):67684. |
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