凝血及纤溶因子水平对新生儿弥散性血管内凝血的诊断价值

Diagnostic value of coagulation and fibrinolytic factors levels in neonatal DIC

目的探讨血浆凝血酶-抗凝血酶复合物(TAT)、D-二聚体(D-D)、纤维蛋白原降解产物(FDP)检测在早期诊断新生儿弥散性血管内凝血(DIC)中的价值。方法将收治的105例危重患者作为研究组,所有患儿新生儿危重病例评分小于或等于90分;其中诊断为pre-DIC患儿57例;另选同期在妇产科出生的60例健康新生儿作为对照组。对弥散性血管内凝血前状态(pre-DIC)患儿采用小剂量肝素治疗,对比各组血浆D-D、TAT、FDP水平。结果与对照组相比,危重患儿血浆D-D、TAT、FDP水平明显升高,两组间相比差异有统计学意义(P<0.05);治疗后pre-DIC患儿血浆D-D、TAT、FDP水平降低至正常水平内,与治疗前相比差异有统计学意义(P<0.05)。相关性分析显示血浆D-D、TAT、FDP水平与危重病例评分呈明显负相关关系(P<0.05);D-D、TAT、FDP联合检测能够明显提高诊断的敏感性和特异性。结论血浆D-D、TAT、FDP检测可以作为新生儿DIC早期诊断和干预治疗的依据。

Objective To explore the value of plasma TAT ,D‐D and FDP detection in early diagnosis of neo‐natal disseminated intravascular coagulation （DIC） .Methods 105 neonatal cases of critically ill in our hospital were taken as the study group ,all cases had the neonatal critical illness score of ≤ 90;among them ,57 cases were pre‐DIC ;contemporaneous 60 healthy neonates were selected as the control group .Pre‐DIC was treated with low dose heparin .The plasma D‐D ,TAT and FDP levels were compared among various groups .Results Compared with the control group ,the plasma D‐D ,TAT and FDP levels in the critically ill group were increased significantly ,the differ‐ence was statistically significant between the two groups （P〈 0 .05）;the plasma D‐D ,TAT and FDP levels after treatment in the pre‐DIC group were decreased to the normal level ,compared with before treatment ,the difference was statistically significant（P〈0 .05） .The correlation analysis showed that the significantly negative correlation ex‐isted between plasma D‐D ,TAT and FDP levels with the critical illness score （P〈0 .05）;the combined detection of D‐D ,TAT and FDP could significantly improved the sensitivity and specificity of diagnosis .Conclusion Plasma D‐D , TAT and FDP detection can be used as the basis for early diagnosis and interventional treatment of neonatal DIC .