国际血栓与止血协会标准评分与日本卫生福利部标准评分对危重症患者弥漫性血管内凝血的诊断价值比较  

Diagnostic Value on DIC in Patients with Critical Disease:a Comparison between ISTH Score and JMHW Score

作　　者：曹江涛[1] 郑雅茹 赵世峰[1] CAO Jiang-tao;ZHENG Ya-ru;ZHAO Shi-feng(Department of Respiratory and Critical Care Medicine,General Hospital of the Chinese People's Liberation Army,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院呼吸与危重症医学科,北京市100853

出　　处：《实用心脑肺血管病杂志》2018年第9期75-78,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的比较国际血栓与止血协会标准(ISTH)评分与日本卫生福利部标准(JMHW)评分对危重症患者弥漫性血管内凝血(DIC)的诊断价值。方法选取2016年1月—2017年10月中国人民解放军总医院收治的有DIC倾向的危重症患者480例。所有患者入院后每隔5 h监测1次实验室检查指标并计算ISTH评分和JMHW评分。比较ISTH评分和JMHW评分对DIC的诊断时间,DIC患者和非DIC患者30 d内病死率,ISTH评分和JMHW评分对危重症患者DIC的诊断价值;绘制ROC曲线以评价ISTH评分和JMHW评分对危重症患者死亡的预测价值。结果 42例患者发生DIC,JMHW评分诊断危重症患者DIC的时间短于ISTH评分(P<0.05)。ISTH评分诊断危重症患者DIC的灵敏度为90.5%,特异度为100.0%,约登指数为0.905;JMHW评分诊断危重症患者DIC的灵敏度为100.0%,特异度为99.1%,约登指数为0.991。DIC患者和非DIC患者入院30 d内病死率比较,差异无统计学意义(P>0.05)。ROC曲线显示,ISTH评分预测危重症患者死亡的曲线下面积(AUC)为0.875,JMHW评分预测危重症患者死亡的AUC为0.980。结论与ISTH评分相比,JMHW评分能更及时、有效地诊断危重症患者DIC,且对危重症患者预后的预测价值较高。Objective To compare the diagnostic value on DIC in patients with critical disease between ISTH score and JMHW score.Methods A total of 480 critical disease patients with high risk of DIC were selected in General Hospital of the Chinese People's Liberation Army from January 2016 to October 2017.Laboratory examination results were monitored per 5 hours after admission to calculate the ISTH score and JMHW score.Diagnostic time for DIC and diagnostic value on DIC were compared between ISTH score and JMHW score,fatality rate within 30 days after admission was compared in critical disease patients complicated with DIC or not;ROC curve was drawn to evaluate the predictive value of ISTH score and JMHW score on death in patients with critical disease.Results Of the 480 patients,42 cases occurred DIC,diagnostic time for DIC of JMHW score was statistically significantly lower than that of ISTH score(P<0.05).The sensitivity of ISTH score in diagnosing DIC in patients with critical disease was 90.5%,the specificity was 100.0%,the Youden index was 0.905,that of ISTH score was 100.0%,99.1%,0.991,respectively.No statistically significant differences of fatality rate was found within 30 days after admission in patients complicated with DIC or not(P>0.05).ROC curve showed that,AUC of ISTH score in predicting death in patients with critical disease was 0.875,that of JMHW score was 0.980.Conclusion Compared with ISTH score,JMHW score can more timely and effectively diagnose DIC in patients with critical disease,with higher predictive value on death.

关 键 词：弥漫性血管内凝血 危重病 国际血栓与止血协会标准 日本卫生福利部标准 诊断 

分 类 号：R544.8[医药卫生—心血管疾病]