产科弥散性血管内凝血实验室诊断评价分析

Evaluation of laboratory diagnosis of obstetric disseminated intravascular coagulation

目的评价临床实验室常用凝血指标用于产科弥散性血管内凝血(disseminated intravascularcoagulation,DIC)诊断的性能,为产科DIC诊断提供合理的实验依据。方法回顾性分析230例纳入病例的凝血指标变化情况,包括纤维蛋白原(fibrinogen,FIB)含量、血浆凝血酶原时间(prothrombin time,PT)、血小板(platelet,PLT)计数、D二聚体(D-dimer,D-D)水平、血浆纤维蛋白(原)降解产物(fibrin/fibrinogen degradationproducts,FDP)含量、抗凝血酶Ⅲ(antithrombin-Ⅲ,AT-Ⅲ)活性等指标,评价这些临床常用凝血指标对产科DIC诊断的敏感度和特异性,寻找各凝血指标用于产科DIC诊断的最佳诊断界值。结果在纳入的230例患者中,根据本院DIC诊断标准,经临床表现、体征和实验室资料综合分析,64例最终被诊断并发DIC。受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析,各指标的诊断界值分别为:AT-Ⅲ活性≤75%,FDP≥8.9μg/ml,FIB≤3.35g/L,D-D>350μg/L,PLT≤124×109/L,PT>10.8s,与本院现用的诊断界值均存在明显差异,P值均<0.001。将各凝血指标两两分析结果显示:AT-Ⅲ活性与其它凝血指标比较,P值均<0.05;所有凝血指标与PT比较,P值均<0.001。结论 AT-Ⅲ对产科DIC的判断性能最佳,PT测定诊断性能最差。本院现用DIC诊断标准并不完全适合于产科DIC的诊断;本研究初步寻找出各凝血指标适合于产科这一特殊人群的DIC诊断界值,但还需要进一步作前瞻性验证。

Objective To evaluate clinical efficacy of coagulation parameters used for the diagnosis of obstetric disseminated intravascular coagulation （DIC） performance, such as fibrinogen （FIB） assay, prothrombin time （PT）, platelet （PLT） counts, D-dimer measurement, fibrin/fibrinogen degradation products （ FDPs ） levels, antithrombin- III （AT- III ） activity. Methods A total of 230 obstetric cases screened for DIC were retrospectively analysed in this hospital. Their coagulation parameters were detected and the sensitivity and specificity were evaluated for DIC. The best diagnostic cutoff value of these paremeters was calculated for the diagnosis of obstetric DIC. Results Out of the 230 cases,64 cases were proven with DIC by clinical manifestation, sighs and laboratory data. The calculated cutoff values, as determined by receiver operating characteristic curve analysis, of AT-III activity, FDPs, FIB, D-dimer, PLT, PT were ≤ 75 %, ≥8. 9 μg/ml,≤ 3. 35 g/L, 〉 350 μg/L, ≤124 × 10^9/L, 〉 10. 8 s, respectively. Paired comparison between ROC curves of AT III and other coagulation parameters was found with statistical significance （P,0.05）, and similar result was seen by paired comparison between ROC curves of PT and other coagulation parameters（P〈0. 001）. Conclusions The diagnostic performance of AT-III activity is best for obstetric DIC, but PT is worst. DIC diagnostic criteria currently used in this hospital is not entirely suitable for the diagnosis of obstetric DIC. The cutoff values of coagulations proposed in this study for obstetric DIC require further prospective validation.