儿童发生DIC的血栓弹力图指标变化及其诊断DIC的敏感度和特异度分析

发布时间：2018-03-12 10:17

本文选题：儿童　切入点：DIC　出处：《中国实验血液学杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的:探讨分析血栓弹力图指标变化对儿童发生弥散性血管内凝血(DIC)诊断的敏感度和特异度的影响。方法:选取武汉市儿童医院新生儿科2013年6月至2016年6月期间收治的149例发生DIC儿童为DIC组,同期另选106例非DIC组(包括健康儿童以及临床易与DIC混淆的疾病患儿)作为对照组。对DIC组和对照组均检测D-二聚体、血栓弹力图、凝血功能4项、先天性凝血功能紊乱以及血小板计数。统计数据并计算血栓动力图α角、MA、A值、R时间的敏感度和特异度,分析DIC发生与其各指标的关联性,比较在诊断DIC时血栓弹力图和常规凝血功能之间的差异。结果:对2组的临床资料统计分析显示,对照组平均R时间明显短于DIC组(P0.05);对照组平均α角大于DIC组(P0.05);对照组的MA值和A值均明显大于DIC组(P0.05)。常规凝血功能检测的指标诊断DIC的特异度分别为血浆凝血酶原时间(PT)27.2%,活化的部分凝血活酶时间(APTT)42.2%,国际标准化比值(INR)47.9%,纤维蛋白原(FIB)44.4%,血浆纤维蛋白降解产物(FDP)42.7%,D-二聚体(D-dimer)68.3%,明显低于R时间、α角和MA值诊断DIC的特异度:85.1%、74.1%、73.0%。健康儿童α角和MA值则大于重症肝病出血患儿(P0.05);平均R时间少于重症肝病出血患儿(P0.05);A值差异无统计学意义(P0.05)。健康儿童平均R时间少于先天性凝血功能紊乱患儿(P0.05);健康儿童和先天性凝血功能紊乱患儿α角、MA值和A值差异之间均无统计学意义。结论:儿童患DIC时,相比较于常规凝血功能检测,血栓弹力图诊断DIC的特异性明显更高。血栓弹力图能更明确地诊断DIC,与常规凝血功能检测互补,能更早地发现并诊断儿童DIC,提高DIC患儿的生存率。
[Abstract]:Objective: to investigate the effect of changes of thromboelastograms on the sensitivity and specificity of DICs in children with disseminated intravascular coagulation. Methods: from June 2013 to June 2016, the pediatrics of pediatrics in Wuhan Children's Hospital were selected. 149 cases of DIC occurred in DIC group. At the same time, 106 cases of non DIC group (including healthy children and children with diseases easily confused with DIC) were selected as control group. Ddimer, thromboelastogram and coagulation function were detected in both DIC group and control group. Congenital coagulation disorder and platelet count. The sensitivity and specificity of the time of 伪 carrageenan A value of thrombodynamics were calculated, and the correlation between the occurrence of DIC and its indexes was analyzed. To compare the difference between thromboelastogram and conventional coagulation function in the diagnosis of DIC. Results: the clinical data of two groups were statistically analyzed. The mean R time of the control group was significantly shorter than that of the DIC group, the average 伪 angle of the control group was larger than that of the DIC group, and the MA and A values of the control group were significantly higher than that of the DIC group. The specificity of the routine coagulation function test for the diagnosis of DIC was plasma thrombin. The activated partial thromboplastin time was 42.2%, the international standard ratio was 47.9%, the fibrinogen FIBN 44.44.40.The plasma fibrinogen degradation product was 42.7D dimer 68.3, which was significantly lower than the R time, the specificity of 伪 horn and MA value in diagnosing DIC was 85.14.11.The specificity of DIC was 73.0.The specificity of the diagnostic value of 伪 -horn and MA was 85.14.10.The specificity of DIC was 73.0.The specificity of the diagnostic value of 伪 -horn and MA was 85.14.10.The specificity of the diagnosis of DIC was 73.0.The specificity of the diagnostic value of 伪 -horn and MA was 85.14.10.The specificity of the diagnosis of DIC was 73.0. The values of angle and MA were higher than those of children with severe hepatic hemorrhage (P0.05A), the mean R time was less than that of patients with severe liver bleeding (P0.05A), the mean R-time of healthy children was less than that of children with congenital coagulation dysfunction (P0.05N), the mean R time of healthy children was less than that of children with congenital coagulation disorder (CCF), and that of healthy children (P < 0.05). There was no significant difference between MA value and A value in children with congenital coagulation disorder. Conclusion: in children with DIC, there is no significant difference. Thromboelastography was more specific than conventional coagulation in the diagnosis of DIC. Thromboelastography could be used to diagnose DIC more clearly, complement with routine coagulation function test, detect and diagnose DICs earlier, and improve the survival rate of DIC children.
【作者单位】：华中科技大学同济医学院附属武汉儿童医院;
【分类号】：R725.4

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