血栓弹力图对急性型DIC患者诊断价值

Analysis of thromboelastography in the diagnosis of acute DIC

目的分析血栓弹力图对急性型DIC患者诊断价值。方法对入组的217例疑似DIC患者进行常规凝血指标和血栓弹力图（TEG）检测。根据中国弥散性血管内凝血诊断积分系统将患者分为DIC组和非DIC组,比较2组的TEG结果,并对DIC组的TEG结果进行ROC曲线分析。结果82例患者确诊为DIC,135例患者为非DIC。DIC组的R时间、K时间、α角、MA值、LY30分别为：（12.3±5.7）min、（8.9±4.8）min、（40.4±12.3）°、（35.0±9.6）mm、（9.7±4.9）%,非DIC组的分别为：（6.5±2.8）min、（3.5±2.2）min、（59.0±5.8）°、（48.2±7.0）mm、（3.4±1.3）%。DIC组的R时间、K时间、LY30〉非DIC组,α角、MA值比非DIC组小,各差异有统计学意义（P〈0.05）;TEG各指标中只有α角的曲线下面积（AUC）〉0.9,其诊断的敏感度为83.7%,特异度为89.0%;TEG评分诊断DIC的AUC为0.960,TEG评分≥3时,约登指数最高。结论TEG检测对急性型DIC诊断有一定价值;对疑似DIC的患者,结合TEG检测结果,有助于DIC的准确诊断。

Objective To evaluate the potential value of thrombelastography in the diagnosis of acute DIC. Methods A total of 217 suspected DIC patients were enrolled in the routine coagulation test and thromboelastography（TEG） test. The patients were divided into the DIC group and the non-DIC group according to the diagnostic system of disseminated intravascular coagulation in China. The TEG results of the two groups were compared. The TEG results of the DIC group were analyzed by ROC curve analysis. Results 82 patients were diagnosed as DIC. 135 patients were non-DIC. The R time,K time,LY30,α angle and MA values of the DIC group were（12. 3±5. 7） min,（8. 9±4. 8） min,（40. 4±12. 3） °,（35. 0±9. 6） mm;and（6. 5±2. 8） min,（3. 5±2. 2） min,（59. 0±5. 8） °,（48. 2±7. 0） mm,（3. 4±1. 3） % in the non-DIC group. The R time,K time and LY30 of the DIC group were larger than that of the non-DIC groups,and the α angle and MA values were smaller compared to the non-DIC groups. The differences were statistically significant（P〈0. 05）; Among all the TEG indexes,only the area under the curve（AUC） of α angle was more than 0. 9 with a sensitivity of 83. 7% and a specificity of 89. 0%; the AUC of TEG diagnosing DIC was 0. 960. The Youden＇s index was highest when TEG≥3. Conclusion TEG presented certain value in the diagnosis of acute DIC. For patients with suspected DIC,TEG test may help to pull accurate diagnosis of DIC.