弥散性血管内凝血患者TM、TAT、PIC、D-D水平变化及预测价值分析  

Analysis of Changes and Predictive Value of TM,TAT,PIC and D-D Levels in Patients with Disseminated Intravascular Coagulation

作　　者：张晓莉 杨思蕴 吴敏华 蒋秀娣[1] 王克翔[1] ZHANG Xiao-li;YANG Si-yun;WU Min-hua;JIANG Xiu-di;WANG Ke-xiang(Shanghai Seventh People's Hospital,Shanghai,200137,China)

机构地区：[1]上海市第七人民医院,上海200137

出　　处：《现代生物医学进展》2024年第13期2450-2454,共5页Progress in Modern Biomedicine

基　　金：上海市卫生健康委员会临床科研专项面上项目(202040165);上海市浦东新区卫生健康委员会薄弱学科建设项目(PWZbr2022-08)。

摘　　要：目的:探究弥散性血管内凝血(DIC)患者血栓调节蛋白(TM)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-抗纤溶酶复合物(PIC)、D-二聚体(D-D)水平变化及预测价值。方法:回顾性分析2020.6-2023.6我院收治的80例疑似DIC患者临床资料,根据其综合诊断结果分为DIC组(48例)和非DIC组(32例),比较两组患者入院时血清TM、TAT、PIC、D-D水平及国际血栓与止血委员会的DIC评分系统(ISTH)评分情况差异,经受试者工作特征(ROC)曲线评估入院时血清TM、TAT、PIC、D-D水平在DIC早期诊断中的效能。经pearson相关系数评估DIC患者入院时血清TM、TAT、PIC、D-D水平与ISTH评分的关系。记录DIC组患者3个月的生存状态,将其分为存活组与死亡组,比较其入院时TM、TAT、PIC、D-D水平差异。结果:DIC组患者TM、TAT、PIC、D-D水平及ISTH评分显著高于非DIC组(P均<0.05);TM、TAT、PIC及D-D联合诊断效能最高,其AUC为0.926,特异度为87.50%,敏感度为87.50%,且四者水平均与ISTH评分呈正相关(P均<0.05);死亡组TM、TAT、PIC、D-D水平高于存活组(P均<0.05)。结论:TM、TAT、PIC及D-D联合可提高早期DIC诊断效能,预测DIC预后,为临床治疗提供最佳时机。Objective:To explore the changes and predictive value of thrombomodulin(TM),thrombin-antithrombin complex(TAT),plasmin-antiplasmin complex(PIC)and D-dimer(D-D)in patients with disseminated intravascular coagulation(DIC).Methods:The clinical data of 80 patients with suspected DIC admitted to Shanghai Seventh People's Hospital from June 2020 to June 2023 were retrospectively analyzed.According to the comprehensive diagnosis results,thepatients were divided into DIC group(48 cases)and non-DIC group(32 cases).The differences in serum TM,TAT,PIC and D-D levels and International Society of Thrombosis and Hemostasis(ISTH)DIC scoring systemscore were compared between the two groupsat admission.Receiver operating characteristic(ROC)curve was used to evaluate the efficiency of serum TM,TAT,PIC and D-D levels at admission in the early diagnosis of DIC.Pearson correlation coefficient was applied to evaluate the relationship between serum TM,TAT,PIC and D-D levelsat admission and ISTH scorein patients with DIC.The 3-month survival status of patients in DIC group was recorded and the patients were classified into survival group and death group,and the differences in levels of TM,TAT,PIC and D-D at admission were compared.Results:The levels of TM,TAT,PIC and D-D and ISTH score in DIC group were significantly higher than those in non-DIC group(all P<0.05).The combined diagnosis with TM,TAT,PIC and D-D had the highest efficiency,with AUC of 0.926,specificity of 87.50%and sensitivity of87.50%,and the levels of the four indicators were positively correlated with ISTH score(all P<0.05).The levels of TM,TAT,PIC and D-D were higherin death group than those in survival group(all P<0.05).Conclusion:The combination of TM,TAT,PIC and D-D can improve the diagnostic efficiency of early DIC,predict the prognosis of DIC,and provide the best timing for clinical treatment.

关 键 词：血栓调节蛋白 弥散性血管内凝血 血酶-抗凝血酶复合物 纤溶酶-抗纤溶酶复合物 D-二聚体 

分 类 号：R554.8[医药卫生—血液循环系统疾病] R446[医药卫生—内科学]