新型凝血和血小板功能分析仪在弥散性血管内凝血早期诊断中的价值

摘要

目的：评价凝血和血小板功能分析仪（ Sonoclot ）对重症患者并发弥散性血管内凝血（ DIC）的诊断价值。方法回顾性分析具有DIC潜在危险因素、临床表现或实验室检查疑诊DIC患者，依据国际血栓与止血学会（ ISTH）评分分为显性DIC组237例，非显性DIC组261例。观察年龄、性别、APACHE Ⅱ评分，并根据不同时间段进行常规凝血指标、血常规、D-二聚体、Sonoclot仪器指标检测。 ROC曲线分析评价Sonoclot 仪器指标的DIC诊断价值。结果两组年龄、性别比较差异无统计学意义，ISTH评分、APACHEⅡ评分比较差异有统计学意义（ P＜0．05）。在Sonoclot仪器各量化指标中，在早期（入院6 h内）激活凝血时间（ ACT ）、ACT联合凝血速率（ CR）在ROC曲线下面积分别为0．891和0．959，差异有统计学意义（P＜0．01），ACT诊断DIC特异度为96．2％，敏感度为76.7％，当ACT联合CR后敏感度上升至93．3％，特异度为86．8％。6～12 h指标检测中，ACT联合CR特异度最高达87．5％。而在后期（12 h后） Sonoclot 分析仪指标的敏感度及特异度则远小于传统的凝血指标。结论 Sonoclot 分析仪对DIC患者发生的凝血功能障碍作出早期的判断，为临床早期诊断DIC的有效选择。%[ Abstrcat] Objective To evaluate the role of new coagulation and platelet function analysis (Sonoclot) in the predicting the occurrence of DIC .Methods Tow hundreds and thirty-seven cases of patients with suspected DIC according to the potential risk factors , clinical symptoms and experimental data were retrospectively included and divided into 2groups : overt DIC group with DIC score≥5 and non-overt DIC group with DIC score <5.Age, gender and APACHEⅡscores were recorded , and regular coagulation tests , routine blood test , D-dimer and sonoclot tests were performed at different time points.ROC curves were applied to evaluate the effect of sonoclot parameters .Results There were no differences in age , gender between 2 groups except for the ISTH scores and APACHEⅡscores ( P<0.05).During the early 6 h, the AUC of ACT and ACT combined with CR were0.891 and 0.959, respectively.For the single ACT to predict DIC, the specificity was 96.2% and the sensitivity was 76.7%.When combined with CR , both the specificity and the sensitivity role were increased to 93 .3%and 86.8%, respectively.Within 6~12 h, the combined specificity of ACT and CR in predicting DIC was 87.5%.After12 h, the sensitivity and specificity of the parameters in Sonoclot were much lower than those of routine coagulation indexes .Conclusion Sonoclot analysis can predict the coagulation dysfunction in the patients with DIC in early stage , and effectively diagnose and monitor the clinical course of DIC.