Objective:To investigate the influence of thrombelastography index changes on its sensitivity and specificity for diagnosis of disseminated intravascular coagulation (DIC) in children.Methods:A total of 149 children with DIC in our hospital from June 2013 to June 2016 were selected in DIC group,while 106 cases of non-DIC,including healthy children and children with diseases easily confused with DIC,were selected as non-DIC (control) group.The thrombelastography,D-dimer,coagulation functions including prothrombintime (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB) and fibin degradation product (FDP),congental coagulation disorders and platelet count were detected in DIC and non-DIC groups;the statistics of data was performed and the sensitivity and specificity of thromelastraphy indexes such as R time,α angle MA value and A value were evaluated;the relationship of DIC with indexes was analyzed.Moreover,the result difference of thromelastography and routine coagulation function test was compared at diagnosis of DIC.Results:According to statistical analysis of clinical data in 2 groups,the average R time in non-DIC group was significantly less than that in DIC group (P ＜ 0.05);the average α angle in non-DIC group was larger than that in DIC group (P ＜ 0.05),both the MA and A values in the non-DIC group were significantly higher than those in DIC group (P ＜ 0.05).The specificity of routine coagulation function test for diagnosis of DIC was as follow:PT-27.2 ％,APTT-42.2 ％,international normalized ratio (INR)-47.9 ％,FIB-44.4 ％,FDP-42.7 ％ and D-dimer-68.3％,which were significantly lower than that of R time,α angle and MA value for diagnosis of DIC (85.1％,74.1％ and 73％).The α angle and MA value of healthy children were greater than those of children with severe liver disease(P ＜ 0.05).while the average R time of healthy children was less than that of children with severe liver disease (P ＜ 0.05),but the difference of A value between them did not statistically significant (P ＞ 0.05).The average R time of healthy children was less than that of children with congenital coagulation disorders (P ＜ 0.05).but there was no significant differences in α angle MA and Avalues between them.Conclusion:As compared with routine coagulation function test,the thrombelastography shows more high specificity for diagnosis of DIC,and can more precisely diagnose the DIC;moreover,the thrombelastography combined with roatime coagulation function test can more early find and diagnose the DIC in children,therefore it can improve the survival rate of children with DIC.%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(P＜0.05);对照组平均α角大于DIC组(P＜0.05);对照组的MA值和A值均明显大于DIC组(P＜0.05).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％.健康儿童仅角和MA值则大于重症肝病出血患儿(P＜0.05);平均R时间少于重症肝病出血患儿(P＜0.05);A值差异无统计学意义(P＞0.05).健康儿童平均R时间少于先天性凝血功能紊乱患儿(P＜0.05);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.
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