凝血与纤溶标志物联合检测对早期诊断重症感染引发弥散性血管内凝血的价值  

Combined Test of Coagulation and Fibrinolysis Markers in Early Diagnosis of DIC Caused by Severe Infection

作　　者：王猛[1] 于丹军[1] 刘匀[1] 张洪东 王建新[1] 王春华[1] 张晓清[2] WANG Meng;YU Danjun;LIU Yun;ZHANG Hongdong;WANG Jianxin;WANG Chunhua;ZHANG Xiaoqing(Department of Clinical Laboratory,the First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China;Key Laboratory of Clinical Laboratory Diagnostics of Ministry of Education,College of Laboratory Medicine,Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]秦皇岛市第一医院检验科,河北秦皇岛066000 [2]重庆医科大学检验医学院临床检验诊断学教育部重点实验室,重庆400016

出　　处：《贵州医科大学学报》2020年第7期822-826,853,共6页Journal of Guizhou Medical University

基　　金：国家自然科学基金项目(81401228)。

摘　　要：目的:探讨凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2抗纤溶酶复合物(PIC)、血栓调节蛋白(TM)、组织型纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物(t-PAIC)4项凝血与纤溶标志物对重症感染引发弥散性血管内凝血(DIC)的早期诊断价值。方法:选取重症感染引发的DIC疑似患者86例,根据国际血栓与止血学会(ISTH)积分诊断标准,将患者分成显性DIC组(n=29)、DIC前期组(n=15)、非显性DIC组(n=42),比较3组患者入住ICU当日的血浆TAT、PIC、TM、t-PAIC水平及常规凝血指标[血小板(PLT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、D二聚体(D-dimer,D-D)、纤维蛋白原降解产物(FDP)],采用受试者工作特征(ROC)曲线下面积(AUC)评价TAT、PIC、TM、t-PAIC单项或联合检测对重症感染引发DIC的早期诊断价值。结果:显性DIC组、DIC前期组患者的血浆TAT、TM、t-PAIC的水平高于非显性DIC组、差异有统计学意义(P<0.05),显性DIC组与DIC前期组比较、差异无统计学意义(P>0.05);3组患者血浆PIC水平比较,差异无统计学意义(P>0.05);ROC分析结果显示,TAT、TM、t-PAIC联合检测早期诊断重症感染引发DIC的价值也比单项检测高。结论:TAT、TM及t-PAIC联合检测对早期诊断重症感染引发DIC的具有较高的价值。Objective:To investigate the combined test value of thrombin-antithrombin complex(TAT),α2-plasmininhibitor-plasmin complex(PIC),thrombomodulin(TM),tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAIC))and fibrinolysis markers in the early diagnosis of disseminated intravascular coagulation(DIC)caused by severe infection.Methods:86 patients with suspected DIC caused by severe infection were divided into three groups according to the International Society of Thrombosis and Hemostasis(ISTH)Integral System:overt-DIC group(n=29),pre-DIC group(n=15),and non-overt DIC group(n=42).The levels of TAT,PIC,TM,t-PAIC and conventional coagulation index including platelet(PLT),prothrombin time(PT),fibrinogen(Fib),D-dimer(D-D),fibrinogen degradation product(FDP)in plasma were compared among three groups on the day of admission to ICU.Area under curve(AUC)of receiver operating characteristic(ROC)was used to evaluate the diagnostic efficacy of TAT,PIC,TM,t-PAIC individually or combined test for DIC caused by severe infection.Results:The levels of TAT,TM and t-PAIC in the overt-DIC group and the pre-DIC group were significantly higher than those of non-overt DIC group,the difference was statistically significant(P<0.05).There was no significant difference in the overt-DIC group and those in the pre-DIC group(P>0.05).There was no significant difference in the levels of PIC among three groups(P>0.05).The results of ROC analysis showed that the combined detection of TAT,TM and t-PAIC could obtain the higher diagnostic efficiency than single marker detection.Conclusion:Combined detection of TAT,TM and t-PAIC on diagnosing DIC caused by severe infection can achieve greater diagnostic efficiency.

关 键 词：弥散性血管内凝血 血栓调节蛋白 重症感染 凝血酶-抗凝血酶复合物 纤溶酶-α2抗纤溶酶复合物 组织型纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物 

分 类 号：R446.11[医药卫生—诊断学]