弥散性血管内凝血中敏感实验室检测指标的观察

The Observision of Senitive Indexes of Laboratory Determination in Disseminated Intravascular Coagulation

目的:对反映弥散性血管内凝血(DIC)敏感的实验室检测指标进行比较分析。方法:检测120例Pre-DIC患者,30例DIC患者及30例健康志愿者血浆中PT、TT、KPTT、Fbg、D-Dimer、sP-选择素、凝血酶调节蛋白及BPC的变化。结果:Pre-DIC组及DIC患者组BPC、Fbg、D-Dimer、sP-选择素及TM与正常对照组比较有统计学差异(P<0.05或P<0.01)。对Pre-DIC组患者进行回顾性分析发现,对于诊断早期DIC的敏感实验室检测指标依次为:sP-选择素、TM、D-Dimer、BPC、Fbg、KPTT、PT、TT。敏感度依次为:96.7％、90.8％、81.7％、80.8％、76、6％、63.3％、56.7％、50.8％;而其特异性分别为60.5％、55.3％、73.7％、47.4％、26.3％、44.7％、42.1％、36.8％。虽然Pre-DIC组患者sP-选择素、TM较正常对照组有不同程度的升高,但其升高程度不及DIC组。随后发生DIC的76例患者sP-选择素TM较非DIC患者升高明显。结论:sP-选择素、TM为DIC时出现异常最早的实验室指标之一,它们反映了患者体内高凝状态及内皮损伤程度,可作为诊断DIC得首选指标。

Objective: To analysis the most sensitive indexes of laboratory determination in disseminated intravascular coagulation. Methods: We measured the changes of platelet count, PT, TT, KPTT, Fbg, D-Dimer, P-selectin and thrombomodulin in 120 cases of Pre-DIC patients, 30 cases of DIC patients and 30 cases of normal controls. Results: The platalet count,Fbg,D-Dimer,P-selectin and thrombomodulin of Pre-DIC group and DIC group had statistic differences compared with normal controls( P< 0.05 or P<0.01). We found the sensitive indexes of laboratory determination in early DIC were: sP-selectin, TM, D-Dimer, Pre-DIC, BPC, Fbg, KPTT, PT, TT, the sensitivity were: 96.7%, 90.8%, 81.7%, 80.8%, 76.6%, 63. 3 % , 56. 7 % , 50.8 % ; and the specificity were 60.5%, 55. 3 % , 73 . 7 % , 47. 4 % , 26 . 3 % , 44 . 7 % , 42. 1 % , 36.8% . Although sP-selectin and TM of Pre-DIC group plasma levels of sP-selectin and TM were markedly higher in subsequent DIC group than the non-DIC group. Conclusion: sP-selectin and TM were two sensitive indexes of laboratory determination in DIC diasnosis, they may give expression to high coagulation and vascular endothelial cell injury and may be the first select indexse in DIC.