止凝血分子标志物测定在儿童感染性疾病并发DIC时早期诊断的价值  

Diagnostic value of hemostatic molecular for early disseminated intravascular coagulation in children with infectious diseases

作　　者：梁昌达[1] 段荣[1] 赖长城[1] 

机构地区：[1]江西省儿童医院血液科,江西南昌330006

出　　处：《实验与检验医学》2013年第4期322-325,共4页Experimental and Laboratory Medicine

基　　金：江西省科技厅资助课题编号(2011ZBBG70015)

摘　　要：目的探讨凝血酶调节蛋白(TM)、凝血酶原片段1+2(F1+2)、D-二聚体(D-D)三种止凝血分子标志物在感染性疾病患儿并发弥散性血管内凝血(DIC)时早期诊断的价值。方法用ELISA方法检测了经血栓与止血国际协会(ISTH)评分法评定疑似DIC的58例感染性疾病患儿和30例健康儿童(健康对照组,A组)的TM、F1+2、D-D;用常规方法检测了58例患儿的血小板(BPC)、血浆凝血酶原时间(PT)、纤维蛋白原(Fg)、纤维蛋白降解产物(FDP)。58例中有10例发展为ISTH评分法评定的DIC。将其分为未转为DIC(B组)和转为DIC(C组),回顾性分析比较两组患儿在DIC疑似阶段的TM、F1+2、D-D、BPC、PT、Fg、FDP及ISTH评分。结果(1)在C组TM、F1+2与B组及A组,有统计学差异(P<0.05),B组与A组无统计学差异(P>0.05);而D-D在三组间无统计学差异;BPC、PT、Fg、FDP及ISTH评分在B组与C组无统计学差异(P>0.05)。(2)在C组中TM、F1+2异常率分别为90%、80%,而B组分别为0%、8%。B组与C组比较D-D、BPC、PT、Fg、FDP异常率无差异。(3)C组10例病例在DIC疑似阶段与确诊阶段D-D比较,在确诊阶段明显升高(P<0.05),而TM、F1+2无差异。结论TM、F1+2有助于儿童感染性疾病并发DIC的早期诊断,且特异性、敏感性较高,D-D动态观察有助于DIC的确诊。Objective To exporle the diagnostic value of thrombomodulin（TM）,prothrombin fragment 1＋2（F1＋2） and D-dimer（D-D） for early disseminated intravascular coagulation（DIC） in children with infectious diseases.Methods D-D were examined in 58 suspected DIC cases with infectious diseases and 30 healthy children（group A） using enzyme-linked immunosorbent assay（ELISA）.Platelet count（BPC）,prothrombin time（PT）,fibrin degradation products（FDP） and fibrinogen（Fg） were examined using routine methods.10 of the 58 cases developed into DIC that determined by ISTH scores.The 58 cases were divided into non-DIC group（group B） and DIC group（group C）.TM,F1＋2,D-D,BPC,PT,Fg and FDP were retrospectively analyzed and compared between group B and group C.Results 1.The TM and F1＋2 were significantly higher in group C than those in group B and group A（P0.05）.There was no significant difference between group A and group B.Whereas the D-D had no significant difference in three groups（P0.05）.There was no significant difference in BPC,PT,FDP,Fg and the ISTH scores between group B and group C;2.The abnormal rate of TM and F1＋2 were significantly higher in group C than those in group B.Whereas the abnormal rare of D-D,BPC,PT,FDP and Fg had no significant difference between group B and group C;3.The D-D in group C was significantly higher in DIC patients than in suspected DIC patients.Conclusion The detection of TM and F1＋2 would be helpful to early diagnosis of DIC in children with infectious diseases and their specificity and sensitivity were high.D-D monitoring would be helpful to DIC diagnosis.

关 键 词：儿童 感染性疾病 止凝血分子标志物 弥散性血管内凝血 早期诊断 

分 类 号：R446.111[医药卫生—诊断学] R554.8[医药卫生—临床医学]