贵州医科大学学报

2020, v.45;No.239(08) 938-942

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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

王猛;于丹军;刘匀;张洪东;王建新;王春华;张晓清;
WANG Meng;YU Danjun;LIU Yun;ZHANG Hongdong;WANG Jianxin;WANG Chunhua;ZHANG Xiaoqing;Department of Clinical Laboratory,the First Hospital of Qinhuangdao;Key Laboratory of Clinical Laboratory Diagnostics of Ministry of Education,College of Laboratory Medicine,Chongqing Medical University;

摘要(Abstract):

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(KeyWords): 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
thrombomodulin(TM);acute leukemia(AL);disseminated intravascular coagulation(DIC);thrombin-antithrombin complex(TAT);plasmin-α2-antiplasmin complex(PIC);tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAIC)

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(81401228)

作者(Author): 王猛;于丹军;刘匀;张洪东;王建新;王春华;张晓清;
WANG Meng;YU Danjun;LIU Yun;ZHANG Hongdong;WANG Jianxin;WANG Chunhua;ZHANG Xiaoqing;Department of Clinical Laboratory,the First Hospital of Qinhuangdao;Key Laboratory of Clinical Laboratory Diagnostics of Ministry of Education,College of Laboratory Medicine,Chongqing Medical University;

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DOI: 10.19367/j.cnki.2096-8388.2020.08.013

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