弥散性血管内凝血早期诊断的实验研究

    李君君1

    陈方平2

    颜家运1

    余海仁1

    颜向军1

    [摘要] 目的:探索弥散性血管内凝血(DIC)早期诊断的实验指标。方法:采用 EL ISA双抗体夹心法测定血

    浆凝血酶原片段 1 + 2 (F1 + 2) 、 D2二聚体(D2D) ,采用免疫浊度法测定血清抗凝血酶 Ⅲ(AT2Ⅲ) 。结果:各期 DIC

    组患者血浆 F1 + 2、 D2D含量均显著升高 ,AT2Ⅲ含量显著降低 ,且与可疑 DIC组及正常对照组比较差异均有极显

    著性意义( P < 0. 01) 。在早期 DIC组中 ,F1 + 2阳性率为 100 % ,D2D 及 AT2Ⅲ阳性率为93. 8 % ,敏感性远远高于

    DIC常规实验室检查。结论:F1 + 2、 AT2Ⅲ、 D2D是能早期反映体内凝血、抗凝及纤溶系统激活的敏感性指标之一 ,在 DIC早期诊断中有着重要实用价值。

    [关键词] 血管内凝血 ,弥散性;凝血酶原片段 1 + 2 ;抗凝血酶 Ⅲ;D2二聚体

    [中图分类号] R554 [文献标识码] A [文章编号] 100422806 (2003) 0220082203

    Experiment study of the early diagnosis of dissminated

    intravascular coagulation

    L I J unjun

    1

    CHEN G Fangping

    2

    YA N Jiayun

    1

    YU Hai ren

    1

    YA N Xiangjun

    1

    (

    1

    Department of Hematology , the First Affiliated Hostiptal ,Nanhua University ,Hengyang 421001 ,China ;

    2

    Department of Hematology ,Xiangya Hospital ,Cont rical South University)

    Abstract Objective :In order to study the laboratory indexes of early Disseminated int ravascular coagulation (DIC)

    diagnosis.Method :67 patients were divided into 3 groups :early stage DIC group , middle and later period DIC group ,suspicious DIC group. F1 + 2 and D2dimer were measured by EL ISA , AT2Ⅲwas measured by immunoturbidimet rische

    method. Result :The Levels of F1 + 2 and D2dimer in early stage DIC group〔(3. 96 ±1. 64 nmoL/ L) , (2. 85 ±1. 36 ,mg/ L) ? x ±s respectively〕and middle and later period DIC group (3. 82±2. 05nmoL/ L) , (6. 12 ±3. 11 mg/ L) were

    ext remely increased , whereas the level of AT 2Ⅲin early stage DIC group (114. 5 ±30. 2 mg/ L) and middle and later

    period DIC group (136. 8 ±33. 5 mg/ L) were decreased. Significant differences of these parameters in each period of

    DIC existed compared with suspicious DIC group and normal cont rols ( P < 0. 01) . F1 + 2 and D2dimer levels in suspi2

    cious DIC group (1. 70 ±0. 33 nmol/ L) , (1. 51 ±1. 42 mg/ L) were increased too , wherease AT 2Ⅲlevel (197. 5 ±

    41. 0 mg/ L) was decreased , Significant differences of these parameters existed as compared with the normals ( P <

    0. 01) . The positive rate of F1 + 2 was ext remely high (100 %) , while D2D and AT2Ⅲwere high too (93. 8 %) . Conclu2

    sion :F1 + 2 ,D2D and AT2Ⅲare sensitive indexes , which can early reflect coagulation , anti2coagulation and Fibrinolysis.

    they had important practical value in the early diagnosis of DIC.

    Key words Disseminated int ravascular coagulation ;Prothrombin f ragment1 + 2 ;Antithrombin Ⅲ; D2dimer

    弥散性血管内凝血(DIC)是发生于许多疾病

    过程中的一种获得性血栓2出血综合征 ,其症状凶

    险 ,进展快速 ,如不及时诊断和处理 ,常常危及生

    命。故当有可能导致 DIC 的基础疾病存在时 ,早

    期诊断、早期预防是 DIC 治疗至关重要的环节。

    本研究通过对血栓前状态部分分子标志物凝血酶

    原片段 1 + 2 ( F1 + 2) 、 D2二聚体(D2D)及血清抗凝

    血酶 Ⅲ(AT2Ⅲ)的定量检测 ,并与常规实验指标比

    较 ,以探讨 3 种指标在 DIC 早期诊断中的应用价

    值 ,为早期诊断和治疗DIC提供新思路。

    1 对象与方法

    1. 1 研究对象

    DIC患者的诊断依据为我国血栓与止血学术

    会议制定的标准〔 1〕;可疑DIC患者均符合: ①存在

    引起DIC的基础疾病; ②具有一项以上 DIC 临床

    1

    南华大学附属第一医院血液科(湖南衡阳 ,421001)

    2

    中南大学湘雅医院血液科

    表现; ③ DIC常规检查异常 ,但达不到诊断标准。

    DIC组:35 例 ,男17 例 ,女18 例;年龄17～68

    岁 ,平均41. 6岁。结合临床病史、体征、实验室检

    测结果 ,根据 DIC 病程将其再分为早期及中晚期

    DIC两组 ,其中重症感染 11 例 ,产科疾病 8 例 ,急

    性白血病 7 例(M34 例 ,M52 例 ,M21 例) ,恶性淋

    巴瘤 2 例 ,恶性组织细胞病(简称恶组) 2 例 ,前列

    腺癌 1 例 ,系统性红斑狼疮 1 例 ,中暑 1 例 ,脑血

    管意外 1 例 ,肺癌术后 1 例 ......