弥漫性血管内凝血实验诊断的系统评价

Systematic review of diagnostic efficiency of laboratory tests used for disseminated intravascular coagulation

目的 评价并比较弥漫性血管内凝血 (DIC)常用实验诊断指标的诊断效能。方法 按照纳入排除标准收集关于DIC实验诊断研究的一次文献 17篇 ,利用Cochrane方法学协作组提供的Meta分析软件及Revman软件进行合并分析。结果 可溶性纤维蛋白单体 (SFM)、纤维蛋白 (原 )降解产物 (FDP)、D 二聚体 (D D)、凝血酶 抗凝血酶复合物 (TAT)、凝血酶原时间 (PT)、抗凝血酶活性 (AT)、硫酸鱼精蛋白副凝固试验 (3P)、部分活化凝血活酶时间 (APTT)、血小板计数 (PLT)、纤维蛋白原含量(FIB)的综合比数比 (OR)分别为 34 2 4、18 2 0、15 5 6、8 86、7 89、6 90、4 71、4 6 6、4 39、2 2 8。SFM、FDP、D D、TAT、PT、AT、3P、APTT和FIB的综合ROC曲线下面积 (AUC)分别为 0 9378、0 9177、0 8793、0 7813、0 7893、0 85 2 9、0 784 9、0 784 2、0 5 5 5 3。不同文献报道D D、3P、AT、FIB、APTT的结果间存在显著异质性 ,P值分别为 0 0 0 0 3、0 0 2 2、0 0 1、0 0 0 0 7、0 0 1。结论 单个实验诊断指标如PLT、FIB、PT和APTT的诊断DIC的价值较低 ,而SFM、FDP、D D的价值较高 ,其次是AT、TAT等。其中FDP的价值在于选择较低水平的界值作为DIC的筛选指标 ,而D

Objective To evaluate and compare the diagnostic efficiency of laboratory tests used for diagnosis of disseminated intravascular coagulation(DIC). Methods 17 original studies were selected based on defined criteria. Meta-analysis and Revman Software supplied by Method Group of Cochrane collaboration were used to analyze the data. Results Odds Ratios (OR) of SFM, FDP, D-D, TAT, PT, AT, 3P, APTT, PLT, FIB, which were outputs of Revman Software, were 34.24, 18.20, 15.56, 8.86, 7.89, 6.90, 4.71, 4.66, 4.39, 2.28, respectively. The area under ROC curve (AUC) of SFM, FDP, D-D, TAT, PT, AT, 3P, APTT, FIB were 0.937 8, 0.917 7, 0.879 3, 0.781 3, 0.789 3, 0.852 9, 0.784 9, 0.784 2, 0.555 3, respectively. For D-D、3P、AT、FIB、APTT, there were significant heterogeneity among the results of different studies ( P =0.000 3, 0.022, 0.01, 0.000 7, 0.01, respectively). Conclusion Based on these results, PLT, PT, APTT, as well as TAT, AT are of lower diagnostic efficiency for DIC. SFM, FDP and D-D are of higher diagnostic efficiency. D-D was more useful as a confirmatory test, whereas FDP was more useful as a screening test.