[1]张 彤,董夏昕,雷 娜,等.血栓四项指标与血栓弹力图参数检测对脓毒血症合并弥散性血管内凝血的早期诊断价值比较[J].陕西医学杂志,2021,50(1):100-102,110.[doi:DOI:10.3969/j.issn.1000-7377.2021.01.027]
　ZHANG Tong,DONG Xiaxin,LEI Na,et al.Comparison of the value of four molecular markers of thrombosis and thromboelastogram in early diagnosis of sepsis with diffuse intravascular coagulation[J].,2021,50(1):100-102,110.[doi:DOI:10.3969/j.issn.1000-7377.2021.01.027]
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血栓四项指标与血栓弹力图参数检测对脓毒血症合并弥散性血管内凝血的早期诊断价值比较
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
50
期数:
2021年1期
页码:
100-102,110
栏目:
临床检验
出版日期:
2021-01-05

文章信息/Info

Title:
Comparison of the value of four molecular markers of thrombosis and thromboelastogram in early diagnosis of sepsis with diffuse intravascular coagulation
作者:
张 彤1; 董夏昕2; 雷 娜1; 张 雯1; 李 雯1; 徐 阳1; 王金华1; 王 琰1; 张 磊1
(1.西安交通大学第二附属医院检验科,陕西 西安 710004; 2.延安大学医学院,陕西 延安 716000)
Author(s):
ZHANG Tong; DONG Xiaxin; LEI Na; ZHANG Wen; LI Wen; XU Yang; WANG Jinhua; WANG Yan; ZHANG Lei
(Department of Laboratory Medicine,Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)
关键词:
弥散性血管内凝血;  脓毒血症;  血栓四项;  血栓弹力图;  一致性评价;  ROC曲线
Keywords:
Disseminated intravascular coagulation;  Sepsis;  Four molecular markers of thrombosis;  Thromboelastogram;  Consistency evaluation;  ROC curve
分类号:
R 543
DOI:
DOI:10.3969/j.issn.1000-7377.2021.01.027
文献标志码:
A
摘要:
目的:比较血栓四项与血栓弹力图对脓毒血症合并弥散性血管内凝血(DIC)的早期诊断价值。方法:选取脓毒血症患者215例,根据中国弥散性血管内凝血诊断积分系统(CDICS)评分分为显性DIC组(CDICS评分≥7分)、非显性DIC组(5分≤CDICS评分<7分)以及未发生DIC的对照组(CDICS评分<5分)。比较三组血栓四项[凝血酶-抗凝血酶复合物(TAT)、血栓调节蛋白(TM)、组织纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物(t-PAI-C)、纤溶酶-α2纤溶酶抑制物复合物(PIC)]及血栓弹力图参数[凝血因子激活时间(R)、血块形成的速率(K)、弹力图最大切角(α角)、弹力图最大振幅(MA)]。采用受试者工作特征(ROC)曲线分析上述指标的诊断效能。对两种检测方法与CDICS评分结果进行Kappa一致性分析。结果:显性DIC组TM、TAT、PIC、t-PAI-C、R、K、α角均高于非显性DIC组,MA低于非显性DIC组(P<0.05)。血栓四项和血栓弹力图单独检测结果虽然有效,但诊断效能低于CDICS评分。血栓四项及血栓弹力图参数与CDICS评分具有弱至中等的一致性(P<0.05)。结论:在脓毒血症合并DIC的早期诊断中,血栓四项阳性诊断率更高,但无法快速、全面地评估凝血全貌,不可代替血栓弹力图的动态监测,临床可以将两者联合应用,进而提高诊断效能。
Abstract:
Objective:To compare the value of four molecular markers of thrombosis and thromboelastogram in the early diagnosis of sepsis with diffuse intravascular coagulation(DIC).Methods:215 patients with sepsis were selected and divided into dominant DIC group(CDICS score≥7)and non-dominant DIC group(5≤CDICS score≤7)and control group without DIC(CDICS score<5).The four molecular markers of thrombosis(TAT,TM,t-PAI-C,PIC)and the parameters of thromboelastogram(R,K,α angle,MA)in three groups were compared.The ROC curve was used to analyze the diagnostic efficacy of the above indicators.Kappa consistency analysis was performed between two detection methods and CDICS score.Results:The TM,TAT,PIC,t-PAI-C,R,K,and α angle of the dominant DIC group were higher than those of the non-dominant DIC group,and MA was lower than that of the non-dominant DIC group(P<0.05).Although the separate test results of four molecular markers of thrombosis and thromboelastogram were effective,the diagnostic efficiency was lower than CDICS score.The four thrombus indexes and the parameters of the thromboelastogram had weak to moderate consistency with CDICS score(P<0.05).Conclusion:In the early diagnosis of sepsis combined with DIC,the positive diagnosis rate of the four thrombus indexes is higher,but it cannot quickly and comprehensively evaluate the coagulation picture.It cannot replace the dynamic monitoring of thromboelastogram.The two can be combined clinically to improve the diagnostic efficiency.

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更新日期/Last Update: 2021-01-05