儿童发生DIC的血栓弹力图指标变化及其诊断DIC的敏感度和特异度分析  

Change of Thrombelastography in Children's DIC and Analysis of Its Sensitivity and Specificity for Diagnosis of DIC

作　　者：袁文浩[1] 刘汉楚[1] 曾凌空[1] 刘晓艳[1] 赵玲霞[1] 莫璐霞[1] 

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院,湖北武汉430016

出　　处：《中国实验血液学杂志》2017年第3期847-852,共6页Journal of Experimental Hematology

摘　　要：目的:探讨分析血栓弹力图指标变化对儿童发生弥散性血管内凝血(DIC)诊断的敏感度和特异度的影响。方法:选取武汉市儿童医院新生儿科2013年6月至2016年6月期间收治的149例发生DIC儿童为DIC组,同期另选106例非DIC组(包括健康儿童以及临床易与DIC混淆的疾病患儿)作为对照组。对DIC组和对照组均检测D-二聚体、血栓弹力图、凝血功能4项、先天性凝血功能紊乱以及血小板计数。统计数据并计算血栓动力图α角、MA、A值、R时间的敏感度和特异度,分析DIC发生与其各指标的关联性,比较在诊断DIC时血栓弹力图和常规凝血功能之间的差异。结果:对2组的临床资料统计分析显示,对照组平均R时间明显短于DIC组(P<0.05);对照组平均α角大于DIC组(P<0.05);对照组的MA值和A值均明显大于DIC组(P<0.05)。常规凝血功能检测的指标诊断DIC的特异度分别为血浆凝血酶原时间(PT)27.2%,活化的部分凝血活酶时间(APTT)42.2%,国际标准化比值(INR)47.9%,纤维蛋白原(FIB)44.4%,血浆纤维蛋白降解产物(FDP)42.7%,D-二聚体(D-dimer)68.3%,明显低于R时间、α角和MA值诊断DIC的特异度:85.1%、74.1%、73.0%。健康儿童α角和MA值则大于重症肝病出血患儿(P<0.05);平均R时间少于重症肝病出血患儿(P<0.05);A值差异无统计学意义(P>0.05)。健康儿童平均R时间少于先天性凝血功能紊乱患儿(P<0.05);健康儿童和先天性凝血功能紊乱患儿α角、MA值和A值差异之间均无统计学意义。结论:儿童患DIC时,相比较于常规凝血功能检测,血栓弹力图诊断DIC的特异性明显更高。血栓弹力图能更明确地诊断DIC,与常规凝血功能检测互补,能更早地发现并诊断儿童DIC,提高DIC患儿的生存率。Objective： To investigate the influence of thrombelastography index changes on its sensitivity and specificity for diagnosis of disseminated intravascular coagulation （DIC） in children. Methods： A total of 149 children with DIC in our hospital from June 2013 to June 2016 were selected in DIC group, while 106 cases of non-DIC, including healthy children and children with diseases easily confused with DIC, were selected as non-DIC （control） group. The thrombelastography, D-dimer, coagulation functions including prothrombintime （PT）, activated partial thromboplastin time （APTT）, fibrinogen （FIB） and fibin degradation product （FDP）, congental coagulation disorders arid platelet count were detected in DIC and non-DIC groups ; the statistics of data was performed and the sensitivity and specificity of thromelastraphy indexes such as R time, ct angle MA value and A value were evaluated; the relationship of DIC with indexes was analyzed. Moreover, the result difference of thromelastography and routine coagulation function test was compared at diagnosis of DIC. Results： According to statistical analysis of clinical data in 2 groups, the average R time in non-DIC group was significantly less than that in DIC group （ P 〈 0.05 ） ; the average et angle in non-DIC group was larger than that in DIC group （ P 〈 0.05 ）, both the MA and A values in the non-DIC group were significantly higher than those in DIC group （ P 〈 0.05 ）. The specificity of routine coagulation function test for diagnosis of DIC was as follow：PT--27.2%, APTT--42.2%, international normalized ratio（INR）--47.9%, FIB---44.4% , FDP---42.7% and D - dimer---68.3 %, which were significantly lower than that of R time, tx angle and MA value for diagnosis of DIC （85.1%, 74.1% and 73% ）. The tx angle and MA value of healthy children were greater than those of children withsevere liver disease（ P 〈 0.05 ）. while the average R time of healthy children was less than that of children with severe liver disease�

关 键 词：儿童 DIC 血栓弹力图 早期诊断 特异度 敏感度 

分 类 号：R554.8[医药卫生—血液循环系统疾病]