联合检测TM、TAT、PIC、t-PAIC水平对DIC的诊断价值

Value of combined detection of the levels of serum TM,TAT,PIC and t-PAIC for the early diagnosis of disseminated intravascular coagulation

目的探讨联合检测血浆中血栓调节蛋白(TM)、凝血酶抗凝酶复合物(TAT)、组织型纤溶酶原激活抑制复合物(t-PAIC)、纤溶酶-抗纤溶酶复合物(PIC)水平在弥散性血管内凝血(DIC)诊断中的临床意义。方法选取急诊重症监护室(ICU)的疑似DIC患者的111例,根据《弥散性血管内凝血诊断中国专家共识(2017版)》中的标准,分为DIC组和非DIC组。在临床怀疑DIC时检测诊断DIC相关凝血指标[血浆凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板(PLT)等]及TM、TAT、t-PAIC、PIC。比较组间TM、TAT、t-PAIC、PIC水平的差异,绘制受试者工作特征曲线(ROC曲线),确定诊断切点及诊断效能。结果DIC组的TM、PIC和t-PAIC值高于非DIC组,差异有统计学意义(P<0.05),两组间TAT差异无统计学意义(P>0.05)。TM、PIC、t-PAIC值诊断DIC的ROC曲线下面积分别为0.716、0.861、0.819;cut-off值分别为:24.950U/mL、2.836μg/mL、13.100ng/mL;灵敏度分别为:60.7%,89.3%,71.4%;特异度分别为:81.0%,82.8%,87.9%,采用联合检测后,灵敏度和特异度分别为65.9%、95.7%。结论联合检测血浆中的TM、t-PAIC和PIC水平等对早期诊断DIC具有临床指导意义。

Objective To evaluate and analyze the value of combined detection of the levels of serum thrombomodulin (TM),thrombin anticoagulase complex (TAT),tissue plasminogen activation inhibitor complex (t-PAIC),plasminogen antifibrinolytic complex (PIC) for the early diagnosis of disseminated intravascular coagulation (DIC). Methods 111 suspected DIC patients admitted to Emergency Intensive Care Unit (ICU) were enrolled.According to Consensus of Chinese Experts on Diagnosis of Disseminated Intravascular Coagulation (Version 2017),the patients were divided into 2 groups:group DIC and group non DIC.Blood was taken when DIC was suspected and then the routine coagulation biomarkers such as plasma prothrombin time (PT),fibrinogen (FIB),D-dimer (D-D) and platelet (PLT) and TM,TAT,t-PAIC,PIC were tested.The difference between groups of these biomarkers was compared,and then the receiver operating characteristic (ROC) curve was drawn to determine the diagnostic cut-off point and diagnostic performance. Results The patients in group DIC had higher levels of TM,PIC,t-PAIC in plasma than those of patients in group non DIC.The area under the ROC curve of TM,PIC,t-PAIC were 0.716,0.861,0.819,respectively and cut-off values were 24.950 U/mL,2.836 μg/mL,13.100 ng/mL,respectively and sensitivity was 60.7%,89.3%, 71.4 %,respectively and specificity was 81.0%,82.8%,87.9%,respectively.With the combined detection,the sensitivity and specificity were 65.9% and 95.7% respectively. Conclusion Combined detection of TM,PIC,t-PAIC has important clinical for the diagnosis of DIC.