纤维蛋白原对DIC患者疾病诊断及预后的价值

The Value of Fibrinogen in the Diagnosis and Prognosis of Patients with DIC

目的评价纤维蛋白原水平对弥散性血管内凝血(DIC)疾病诊断的影响,探究纤维蛋白原输注对DIC疾病预后的意义.方法通过回顾性分析的方法,对2014年5月—2018年5月就诊于苏州大学附属第一医院的110例DIC病人的临床资料进行分析,随机选择同期不具有DIC的110例相同基础疾病的病人作为对照,分析纤维蛋白原水平与DIC病人疾病的诊断、诱因、进展与生存的关系.结果采用2017年中国弥散性血管内凝血诊断积分系统(CDSS)进行DIC诊断,110例DIC病人中男58例,女52例,中位年龄42(13~77)岁,其中恶性血液病65例(59.0%),感染13例(11.8%),实体肿瘤13例(11.8%),病理产科8例(7.3%),手术外伤6例(5.5%),其它疾病5例(4.5%).多因素分析显示APTT延长、PT延长、初始纤维蛋白原较高及最低纤维蛋白原较低均是DIC发生的独立危险因素.DIC病人死亡率40.9%,多因素分析显示DIC病人的年龄、APTT延长、初始纤维蛋白原水平均是28 d内死亡的独立危险因素.经调整后,纤维蛋白原制品输注有效提高了DIC患者纤维蛋白原水平的恢复速度(中位时间分别为9 d和16 d).ROC曲线显示患者的纤维蛋白原水平用于诊断DIC差异有统计学意义,其最佳界值为1.575 g/L.结论纤维蛋白原水平对于DIC患者具有一定诊断意义和预后预测的价值,输注纤维蛋白原制品有助于加速纤维蛋白原水平恢复.

Objective To evaluate the role of fibrinogen level on the diagnosis of disseminated intravascular coagulation(DIC),and to explore the effect of fibrinogen infusion on the prognosis of DIC.Methods The clinical data of 110 patients with DIC admitted in the First Affiliated Hospital of Soochow University from May 2014 to May 2018 were retrospectively analyzed,and another 110 patients with the same underlying diseases but without DIC were randomly selected as a control to analyze the impact of fibrinogen levels on the diagnosis,progression or survival of DIC patients.Results The 2017 Chinese Disseminated Intravascular Coagulation Scoring System(CDSS)was used for the diagnosis of DIC.There were 58 males and 52 females in the DIC group,with a median age of 42(13~77)years old.The underlying diseases of DIC group included 65 patients with hematologic malignancies(59.0%),13 patients with infection(11.8%),13 patients with solid tumors(11.8%),8 patients with pathological pregnancy(7.3%),6 patients with surgical trauma(5.5%),and 5 patients with other diseases(4.5%).Baseline characteristics were comparable between DIC group and the control group.Multivariate analysis showed that prolonged APTT,prolonged PT,higher initial fibrinogen level and lower minimum fibrinogen level were independent risk factors for DIC.The mortality rate of DIC patients was 40.9%.Multivariate analysis showed that age,prolonged APTT and initial fibrinogen level in DIC patients were independent risk factors for death within 28 days.After adjustment,infusion of fibrinogen containing products promoted the recovery of fibrinogen levels(median of 9 days versus 16 days)in patients with DIC.The ROC curve showed that the patients'fibrinogen levels had significant significance for the diagnosis of DIC(P<0.001),and the optimal cut-off value was 1.575 g/L.Conclusion Fibrinogen levels are significant for diagnosing DIC and predicting the prognosis of DIC patients.Infusion of fibrinogen containing products may promote the recovery of fibrinogen level.