血浆凝血与纤溶标志物对急性白血病合并DIC患者早期诊断及预后的评估价值  

The Value of Coagulation and Fibrinolysis Markers in the Early Diagnosis and Prognosis Evaluation of Patients with Acute Leukemia Complicated with DIC

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8期938-942,共5页Journal of Guizhou Medical University

基　　金：国家自然科学基金项目(81401228)。

摘　　要：目的:探讨血浆凝血酶-抗凝血酶复合物(TAT)、纤溶酶-抗纤溶酶复合物(PIC)、血栓调节蛋白(TM)及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)检测对急性白血病(AL)合并弥散性血管内凝血(DIC)的早期诊断及预后评估的价值。方法:62例AL合并DIC疑似患者,根据国际血栓与止血学会(ISTH)积分诊断标准,分为显性DIC组(n=20)、DIC前期组(n=11)及非显性DIC组(n=31),比较入院当日3组患者的血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、D二聚体(D-D)及TAT、PIC、TM、t-PAIC水平;按照患者28 d内生存情况再将患者分为生存组(n=47)与死亡组(n=15),比较入院当日2组患者的血浆TAT、PIC、TM及t-PAIC水平;采用受试者工作特征(ROC)曲线下面积(AUC)评价TAT、PIC、TM及t-PAIC指标单独、或联合检测对AL合并DIC的诊断效能。结果:显性DIC组与DIC前期组患者入院当日血浆TAT、PIC、TM、t-PAIC水平高于非显性DIC组(P<0.05),显性DIC组患者血浆TAT、PIC、TM及tPAIC水平与DIC前期组比较,差异无统计学意义(P>0.05);死亡组患者血浆TAT、PIC、TM及t-PAIC水平高于生存组(P<0.05);ROC曲线分析结果显示,血浆TAT、TM、PIC及t-PAIC联合检测应用于AL合并DIC疑似患者,可获得更大的诊断效能(AUC=0.921)。结论:血浆TAT、PIC、TM及t-PAIC联合检测对AL合并DIC的早期诊断与预后评估具有较高的价值。Objective:To investigate the value of detection of thrombin-antithrombin complex(TAT),plasmin-α2-antiplasmin complex(PIC),thrombomodulin(TM),and tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAIC)in early diagnosis and prognosis evaluation of acute leukemia(AL)complicated with disseminated intravascular coagulation(DIC).Methods:62 AL patients with suspected DIC were divided into three groups according to the International Society of Thrombosis and Hemostasis(ISTH)Integral System:overt-DIC group(n=20),pre-DIC group(n=11),and non-overt DIC group(n=31),the levels of plasma prothrombin time(PT),activated partial thrombin time(APTT),fibrinogen(Fib),D-dimer(D-D),TAT,PIC,TM and t-PAIC were compared in three groups on the day of admission.According to the survival results within 28 days,the patients were divided into survival group(n=47)and death group(n=15),the levels of TAT,PIC,TM and t-PAIC in plasma on the day of admission were compared among patients in the two groups.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of TAT,PIC,TM and t-PAIC for AL complicated with DIC and the prognostic value of TAT,PIC,TM and t-PAIC was evaluated.Results:The levels of TAT,PIC,TM and t-PAIC in overt-DIC group and pre-DIC group were significantly higher than those in non-overt DIC group(P<0.05).There was no significant differences in the levels of TAT,PIC,TM and t-PAIC between overtDIC group and pre-DIC group(P>0.05).The levels of TAT,PIC,TM and t-PAIC in death group were significantly higher than those in survival group.ROC curve analysis results showed that the combined detection of TAT,PIC,TM and t-PAIC could obtain greater diagnostic efficiency,and its diagnostic value was superior to single marker detection.Conclusion:Combined detection of plasma TAT,PIC,TM and t-PAIC has high value in early diagnosis and prognosis evaluation of AL complicated with DIC.

关 键 词：血栓调节蛋白 急性白血病 弥散性血管内凝血 凝血酶-抗凝血酶复合物 纤溶酶-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：R733.71[医药卫生—肿瘤]