弥散性血管内凝血诊断评分标准在产科的应用评价_《华西医学》

作者：

彭萍 ¹ , 张婷 ¹ , 申甫英 ¹ ,  叶德华 ²

成都市龙泉驿区第一人民医院（成都，610100） 1检验科，2妇产科;

关键词：

弥散性血管内凝血诊断标准评价孕产期

DOI：

10.7507/1002-0179.20130591

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　采用已有的4种国际非孕弥散性血管内凝血（DIC）诊断评分标准对产科DIC的诊断进行评估，探索更适合产科DIC诊断的“金标准”。方法　选择2009年6月－2012年6月期间产科拟诊DIC的孕产妇为研究对象，用日本卫生福利部（JMHW）提出的JMHW、日本危重病协会（JAAM）提出的JAAM、国际血栓与止血委员会（ISTH）提出的ISTH显性和ISTH非显性4种诊断评分标准联合诊断和构建“金标准”，以此评价4种诊断标准对产科DIC诊断的特性。结果　受试者工作特征（ROC）曲线分析显示ISTH非显性标准、ISTH显性标准、JMHW、JAAM的ROC曲线下面积分别为0.939、0.865、0.867、0.867，ISTH非显性标准灵敏度和特异度与“金标准”在不同诊断界值时较一致，同时优于其他3种诊断标准。结论　 ISTH非显性标准较适合作为临床产科DIC诊断，其对产科这一特殊发病人群的DIC诊断具有更科学的临床诊断价值。

引用本文： 彭萍,张婷,申甫英,叶德华. 弥散性血管内凝血诊断评分标准在产科的应用评价. 华西医学, 2013, 28(12): 1872-1876. doi: 10.7507/1002-0179.20130591 复制

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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弥散性血管内凝血诊断评分标准在产科的应用评价

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《华西医学》

弥散性血管内凝血诊断评分标准在产科的应用评价

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