临床量表对肺栓塞的诊断价值.PPT

* There are multiple strategies that could potentially be used to block signaling through the ErbB receptors: Monoclonal antibodies (MoAbs) directed toward the extracellular domain of the receptor can be used to prevent interactions with ligands. This approach might also modulate signaling, dimerization, or receptor expression on the cell surface, as well as potentially triggering antibody-dependent cellular cytotoxicity or complement-mediated cytotoxicity. Small molecules directed toward the kinase domain can inhibit phosphorylation and activation of downstream signaling pathways. Receptor antagonists can be used to competitively block ligand binding. Ligands or receptor-specific antibodies can be conjugated to lethal toxins. Following binding to the receptor, the toxin is internalized and kills the tumor cells. Antisense oligonucleotides can be used to downregulate the expression of ErbB receptors or ligands. Vaccines can be made to trigger the immune system to attack tumor cells overexpressing normal or mutant ErbB receptors. While all of these strategies could potentially be used to inhibit ErbB receptors, so far MoAbs and small-molecule kinase inhibitors have been developed to the greatest extent in a clinical setting. * * * 临床量表对肺栓塞的诊断价值 * * 背景 肺栓塞(PE)是一种常见的心肺血管疾病和死亡原因; 临床表现不一，缺乏特异性; 临床漏诊、误诊率高，病死率也较高; 未治疗的PE病死率高达30%，而及时诊治病死率则为2%~8% 背景 近年来，国内外学者开发了一些标准化、客观的临床量表用于PE患病可能性的评估； 最常用的是Wells量表和Geneva量表。以上两种评估量表均来源于欧美国家的资料; 而在我国相关临床论证研究资料仍较少 * * 评价和比较wells量表与Geneva量表对PE的诊断价值，以便完善PE的诊断流程，促进PE的快速正确诊断 目的 方法 回顾性分析1995年1月~2009年1月在我院诊治的可疑PE患者958例的临床资料 分别以Wells量表和Geneva量表进行PE可能性评价将患者划分为PE高度可能、中度可能和低度可能三组 * * 方法 将临床量表评估的中度可能和高度可能组一并定义为阳性，低度可能定义为阴性; 分别以wells量表、Geneva量表对PE进行初步诊断，评价二者的价值并比较其优劣 * * 方法 采用中华医学会呼吸病分会颁布的诊断标准并结合国际推荐标准进行诊断。凡符合以下4项标准之一者即可确诊为PE： ①肺动脉造影阳性或CTPA阳性； ②核素肺通气灌注显像高度可疑； ③核素肺通气灌注显像中度可疑+彩超检查发现下肢DVT； ④临床表现高度可疑+彩超检查发现下肢DVT * * Wells量表 低度可能：0～2分 中度可能：3～6分 高度可能：≥7分 * * Geneva量表 低度可能：0～4分 中度可能：5～8分 高度可能：≥9分 * * 统计