彌散性血管內凝血診斷評分標準在產科的應用評價_《華西醫學》

作者：

彭萍 ¹ , 張婷 ¹ , 申甫英 ¹ ,  葉德華 ²

成都市龍泉驛區第一人民醫院（成都，610100） 1檢驗科，2婦產科;

關鍵詞：

彌散性血管內凝血診斷標準評價孕產期

DOI：

10.7507/1002-0179.20130591

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目的　采用已有的4種國際非孕彌散性血管內凝血（DIC）診斷評分標準對產科DIC的診斷進行評估，探索更適合產科DIC診斷的“金標準”。方法　選擇2009年6月－2012年6月期間產科擬診DIC的孕產婦為研究對象，用日本衛生福利部（JMHW）提出的JMHW、日本危重病協會（JAAM）提出的JAAM、國際血栓與止血委員會（ISTH）提出的ISTH顯性和ISTH非顯性4種診斷評分標準聯合診斷和構建“金標準”，以此評價4種診斷標準對產科DIC診斷的特性。結果　受試者工作特征（ROC）曲線分析顯示ISTH非顯性標準、ISTH顯性標準、JMHW、JAAM的ROC曲線下面積分別為0.939、0.865、0.867、0.867，ISTH非顯性標準靈敏度和特異度與“金標準”在不同診斷界值時較一致，同時優于其他3種診斷標準。結論　 ISTH非顯性標準較適合作為臨床產科DIC診斷，其對產科這一特殊發病人群的DIC診斷具有更科學的臨床診斷價值。

引用本文： 彭萍,張婷,申甫英,葉德華. 彌散性血管內凝血診斷評分標準在產科的應用評價. 華西醫學, 2013, 28(12): 1872-1876. doi: 10.7507/1002-0179.20130591 復制

1.	Watanabe R, Wada H, Miura Y, et al. Plasma levels of total plasminogen activator inhibitor-I (PAI-I) and tPA/PAI-1 complex in patients with disseminated intravascular coagulation and thrombotic thrombocytopenic purpura[J]. Clin Appl Thromb Hemost, 2001, 7(3): 229-233.
2.	Levi M, Cate HT. Disseminated intravascular coagulation[J]. N Engl J Med, 1999, 341(8): 586-592.
3.	Bick RL. Disseminated intravascular coagulation current concepts of etiology, pathophysiology, diagnosis, and treatment[J]. Hematol Oncol Clin North Am, 2003, 17(1): 149-176.
4.	Jonge LD, Meijers J. The diagnosis of disseminated intravascular coagulation[J]. Blood Rev, 2002, 16(4): 217-223.
5.	Mammen EF. Disseminated intravascular coagulation (DIC)[J]. Clin Lab Sci, 2000, 13(4): 239-245.
6.	Gando S, Iba T, Eguchi Y, et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria[J]. Crit Care Med, 2006, 34(3): 625-631.
7.	Thachil J, Toh CH. Disseminated intravascular coagulation in obstetric disorders and its acute haematological management[J]. Blood Rev, 2009, 23(4): 167-176.
8.	Kobayashi N, Maekawa T, Takada M, et al. Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan[J]. Bibl Haematol, 1983(49): 265-275.
9.	Wada H, Wakita Y, Nakase T, et al. Outcome of disseminated intravascular coagulation in relation to the score when treatment was begun. Mie DIC Study Group[J]. Thromb Haemost, 1995, 74(3): 848-852.
10.	Taylor FB, Toh CH, Hoots WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation[J]. Thromb Haemost, 2001, 86(5): 1327-1330.
11.	Toh CH, Downey C. Performance and prognostic importance of a new clinical and laboratory scoring system for identifying non-overt disseminated intravascular coagulation[J]. Blood Coagul Fibrinolysis, 2005, 16(1): 69-74.
12.	Bremme KA. Haemostatic changes in pregnancy[J]. Best Pract Res Clin Haematol, 2003, 16(2): 153-168.
13.	O’Riordan MN, Higgins JR. Haemostasis in normal and abnormal pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2003, 17(3): 385-396.
14.	Brenner B. Haemostatic changes in pregnancy[J]. Thromb Res, 2004, 114(5-6): 409-414.
15.	Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfuction score: a reliable descriptor of a complex clinical outcome[J]. Crit Care Med, 1995, 23(6): 1638-1652.
16.	Hayakawa MG, Hoshino H. A prospective comparative study of three sets of criteria for disseminated intravascular coagulation: ISTH criteria vs Japanese criteria[J]. Clin Appl Thromb Hemost, 2007, 13(1): 65-72.
17.	Gando S, Wada H, Asakura H, et al. Evaluation of new Japanese diagnostic criteria for disseminated intravascular coagulation in critically ill patients[J]. Clin Appl Thromb Hemost, 2005, 11(1): 71-76.

1. 　Watanabe R, Wada H, Miura Y, et al. Plasma levels of total plasminogen activator inhibitor-I (PAI-I) and tPA/PAI-1 complex in patients with disseminated intravascular coagulation and thrombotic thrombocytopenic purpura[J]. Clin Appl Thromb Hemost, 2001, 7(3): 229-233.
2. 　Levi M, Cate HT. Disseminated intravascular coagulation[J]. N Engl J Med, 1999, 341(8): 586-592.
3. 　Bick RL. Disseminated intravascular coagulation current concepts of etiology, pathophysiology, diagnosis, and treatment[J]. Hematol Oncol Clin North Am, 2003, 17(1): 149-176.
4. 　Jonge LD, Meijers J. The diagnosis of disseminated intravascular coagulation[J]. Blood Rev, 2002, 16(4): 217-223.
5. 　Mammen EF. Disseminated intravascular coagulation (DIC)[J]. Clin Lab Sci, 2000, 13(4): 239-245.
6. 　Gando S, Iba T, Eguchi Y, et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria[J]. Crit Care Med, 2006, 34(3): 625-631.
7. 　Thachil J, Toh CH. Disseminated intravascular coagulation in obstetric disorders and its acute haematological management[J]. Blood Rev, 2009, 23(4): 167-176.
8. 　Kobayashi N, Maekawa T, Takada M, et al. Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan[J]. Bibl Haematol, 1983(49): 265-275.
9. 　Wada H, Wakita Y, Nakase T, et al. Outcome of disseminated intravascular coagulation in relation to the score when treatment was begun. Mie DIC Study Group[J]. Thromb Haemost, 1995, 74(3): 848-852.
10. 　Taylor FB, Toh CH, Hoots WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation[J]. Thromb Haemost, 2001, 86(5): 1327-1330.
11. 　Toh CH, Downey C. Performance and prognostic importance of a new clinical and laboratory scoring system for identifying non-overt disseminated intravascular coagulation[J]. Blood Coagul Fibrinolysis, 2005, 16(1): 69-74.
12. 　Bremme KA. Haemostatic changes in pregnancy[J]. Best Pract Res Clin Haematol, 2003, 16(2): 153-168.
13. 　O’Riordan MN, Higgins JR. Haemostasis in normal and abnormal pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2003, 17(3): 385-396.
14. 　Brenner B. Haemostatic changes in pregnancy[J]. Thromb Res, 2004, 114(5-6): 409-414.
15. 　Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfuction score: a reliable descriptor of a complex clinical outcome[J]. Crit Care Med, 1995, 23(6): 1638-1652.
16. 　Hayakawa MG, Hoshino H. A prospective comparative study of three sets of criteria for disseminated intravascular coagulation: ISTH criteria vs Japanese criteria[J]. Clin Appl Thromb Hemost, 2007, 13(1): 65-72.
17. 　Gando S, Wada H, Asakura H, et al. Evaluation of new Japanese diagnostic criteria for disseminated intravascular coagulation in critically ill patients[J]. Clin Appl Thromb Hemost, 2005, 11(1): 71-76.

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彌散性血管內凝血診斷評分標準在產科的應用評價

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《華西醫學》

彌散性血管內凝血診斷評分標準在產科的應用評價

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