纤溶指标对弥漫性血管内凝血的诊断价值

Value of diagnostic indices of fibrinolysis in diffuse intravascular coagulation

关键词:  纤溶指标  DIC  分期  诊断

Key words:  fibrinolysis index  DIC  grouping staging  dignosis

摘要:

［目的］探讨弥漫性血管内凝血（DIC）敏感性和特异性较高的诊断指标应用于临床。［方法］选用BPC、PT、Fbg、APTT、DIC过筛诊断指标，3P、D-D二聚体、TT、FDP、ELT、ATⅢC、α2MG、VWFAg、乙醇胶、红细胞碎片确诊诊断指标，对1629例DIC各期病人及正常对照组进行检测比对分析，找出相关性。［结果］DIC前状态最敏感的指标是3P、ATⅢC、VWFAg，异常率高达100%；其次D-D二聚体，异常率为98.5%；BPC、PT、APTT半数以上异常，Fbg仅有1/3异常，其余各项指标敏感性较差；在消耗性低凝期VWFAg异常率持续增高，BPC、PT 、TT异常率明显升高，而3P、ATⅢC、α2MG仅呈不同程度的增加；纤溶凝衰期时，FDP、ELT、D-D二聚体、红细胞碎片异常率高达100%，其他各项指标均有不同的异常改变。［结论］纤溶指标3P、D-D二聚体、ATⅢC可做DIC高凝前状态的诊断指标，BPC、PT、Fbg、VWFAg可做DIC过筛诊断指标，纤溶指标D-D二聚体、FDP、ELT、α2MG红细胞碎片可做DIC纤溶凝衰期诊断指标。因此，纤溶指标对DIC早期诊断及分型确诊诊断有重要实用价值。

Abstract:

［Objective］To explore the higher diagnostic indices in sensibility and specificity to apply to clinic.［Methods］We selected the sieving diagnostic indices such as BPC,PT,Fbg,APTT,DIC and the final diagnostic indices such as 3P,D-D dimer,TT,FDP,ELT,ATⅢC,α2MG, VWFAg, Alcohol mastic、bib to mesure a total of 1629 patients who were in different stages of DIC or normal comparison and find dependablities.［Results］The most sensitive indices before DIC were 3P,ATⅢC,VWFAg,and its anomal rate reached up to 100%. Of fibrinolysis has a great practical value in the typing and staging dignosis in DIC, the abnormal rate of D-D dimer was 98.5%, more than a half of BPC,PT,APTT and 1/3 of Fbg is preternatural,and other indices is poor in sensibility;the abnormal rate of VWFAg in analosis-low-clotting stage continuing to raise up, the abnormal rate of BPC,PT,TT advanced obviousely,and 3P,ATⅢC,α2MG only heightened at different degrees; During the stage of fibrinolysis exhaustion, the abnormal rate of FDP,ELT,D-D dimer and bib reached up to 100%,and other indices had preternatura transformation;［Conclusion］Firbrinolysis indices such as 3P,D-D dimer,ATⅢC can be regarded as the dignostic indices before DIC high clotting, BPC,PT,Fbg,VWFAg as the sieving diagnostic indices, firbrinolysis indices such as D-D dimer,FDP,ELT,α2MG,bib as the diagnostic indices of the stage of fibrinolysis exhaustion in DIC.Therefore, firbrinolysis indices have important and practical value in early diagnosis and grouping final diagnosis of DIC.