产科DIC诊断中国际ISTH标准与日本标准的评价分析

Comparison of Diagnostic Criteria for Disseminated Intravascular Coagulation in Obstetric Patients:International Society of Thrombosis and Hemostasis Criteria and Japanese Criteria

目的:比较国际血栓与止血委员会显性DIC标准(简称ISTH标准)、日本卫生福利部标准(简称JMHW标准)和日本危重病协会标准(简称JAAM标准)的DIC诊断评分在产科DIC诊断中的可行性,评价其对产科并发DIC的适用性。方法:对产科中因并发症进行DIC筛查的患者230例进行相关凝血指标的测定,分析凝血指标的变化与3种DIC诊断得分标准间的关系。结果:ISTH标准诊断敏感性4.3%,JMHW标准诊断敏感性5.2%,JAAM标准诊断敏感性12.6%。JAAM、JM-HW、ISTH标准各凝血指标均值异常改变程度比较,差异有统计学意义(P<0.05)。诊断为DIC时ISTH、JMHW和JAAM标准的各凝血指标的均值分别为:PTR1.5、1.45、1.3;PLT59.9×109/L、61.7×109/L,71.7×109/L;FIB1.558g/L、1.664g/L、2.262g/L;FDP166.6mg/L、166.2mg/L、122.9mg/L,与其诊断界值不相符合。结论:JAAM标准诊断的敏感性是三者中最高的;现有的3种DIC诊断评分标准对产科DIC的诊断可能不合适;临床需要寻找适合于不同孕周及围生期的各项凝血指标DIC诊断界值,并建立适合产科这一特殊人群的DIC诊断标准。

Objective：To compare the three diagnostic criteria for disseminated intravascular coagulation（DIC）in obstetric patients：ISTH criteria,JMHW criteria and JAAM criteria,and evaluate its applicability in DIC.Methods：230 cases of obstetric complications were included in this study.All patients received DIC screen.We investigated the abnormalities of mean values of PT,FDPs,platelet counts,fibrinogen and their relationships between DIC diagnostic scores.Results：The sensitivity of ISTH criteria,JMHW criteria and JAAM criteria was 4.3%,5.2%,12.6% respectively.The abnormalities of the mean values of various coagulation tests followed by more significantly in patients with DIC by JAAM,JMHW and ISTH criteria（P0.05）.The abnormalities of the mean values of various coagulation tests with DIC are described as following：PTR is 1.5,1.45,1.3 respectively;PLT is 59.9×109L,61.7×109L,71.7×109L respectively;FIB is 1.558 gL,1.664 gL,2.262 gL respectively;FDP is 166.6 mgL,166.2 mgL,122.9 mgL respectively.They were increased but not corresponded to their diagnostic value.Conclusions：The sensitivity of JAAM creteria is the highest ont among them.The three DIC diagnostic creteria are not suitable obstetric DIC,and should consider changes in blood coagulation system during pregnancy for the diagnosis of DIC.The criteria for diagnosis of obstetric DIC can be improved by changing the cutoff values of global coagulation tests.