DIC早期診斷的實(shí)驗(yàn)研究.PDF
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彌散性血管內(nèi)凝血早期診斷的實(shí)驗(yàn)研究
李君君1
陳方平2
顏家運(yùn)1
余海仁1
顏向軍1
[摘要] 目的:探索彌散性血管內(nèi)凝血(DIC)早期診斷的實(shí)驗(yàn)指標(biāo)。方法:采用 EL ISA雙抗體夾心法測(cè)定血
漿凝血酶原片段 1 + 2 (F1 + 2) 、 D2二聚體(D2D) ,采用免疫濁度法測(cè)定血清抗凝血酶 Ⅲ(AT2Ⅲ) 。結(jié)果:各期 DIC
組患者血漿 F1 + 2、 D2D含量均顯著升高 ,AT2Ⅲ含量顯著降低 ,且與可疑 DIC組及正常對(duì)照組比較差異均有極顯
著性意義( P < 0. 01) 。在早期 DIC組中 ,F1 + 2陽性率為 100 % ,D2D 及 AT2Ⅲ陽性率為93. 8 % ,敏感性遠(yuǎn)遠(yuǎn)高于
DIC常規(guī)實(shí)驗(yàn)室檢查。結(jié)論:F1 + 2、 AT2Ⅲ、 D2D是能早期反映體內(nèi)凝血、抗凝及纖溶系統(tǒng)激活的敏感性指標(biāo)之一 ,在 DIC早期診斷中有著重要實(shí)用價(jià)值。
[關(guān)鍵詞] 血管內(nèi)凝血 ,彌散性;凝血酶原片段 1 + 2 ;抗凝血酶 Ⅲ;D2二聚體
[中圖分類號(hào)] R554 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 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
彌散性血管內(nèi)凝血(DIC)是發(fā)生于許多疾病
過程中的一種獲得性血栓2出血綜合征 ,其癥狀兇
險(xiǎn) ,進(jìn)展快速 ,如不及時(shí)診斷和處理 ,常常危及生
命。故當(dāng)有可能導(dǎo)致 DIC 的基礎(chǔ)疾病存在時(shí) ,早
期診斷、早期預(yù)防是 DIC 治療至關(guān)重要的環(huán)節(jié)。
本研究通過對(duì)血栓前狀態(tài)部分分子標(biāo)志物凝血酶
原片段 1 + 2 ( F1 + 2) 、 D2二聚體(D2D)及血清抗凝
血酶 Ⅲ(AT2Ⅲ)的定量檢測(cè) ,并與常規(guī)實(shí)驗(yàn)指標(biāo)比
較 ,以探討 3 種指標(biāo)在 DIC 早期診斷中的應(yīng)用價(jià)
值 ,為早期診斷和治療DIC提供新思路。
1 對(duì)象與方法
1. 1 研究對(duì)象
DIC患者的診斷依據(jù)為我國(guó)血栓與止血學(xué)術(shù)
會(huì)議制定的標(biāo)準(zhǔn)〔 1〕;可疑DIC患者均符合: ①存在
引起DIC的基礎(chǔ)疾病; ②具有一項(xiàng)以上 DIC 臨床
1
南華大學(xué)附屬第一醫(yī)院血液科(湖南衡陽 ,421001)
2
中南大學(xué)湘雅醫(yī)院血液科
表現(xiàn); ③ DIC常規(guī)檢查異常 ,但達(dá)不到診斷標(biāo)準(zhǔn)。
DIC組:35 例 ,男17 例 ,女18 例;年齡17~68
歲 ,平均41. 6歲。結(jié)合臨床病史、體征、實(shí)驗(yàn)室檢
測(cè)結(jié)果 ,根據(jù) DIC 病程將其再分為早期及中晚期
DIC兩組 ,其中重癥感染 11 例 ,產(chǎn)科疾病 8 例 ,急
性白血病 7 例(M34 例 ,M52 例 ,M21 例) ,惡性淋
巴瘤 2 例 ,惡性組織細(xì)胞病(簡(jiǎn)稱惡組) 2 例 ,前列
腺癌 1 例 ,系統(tǒng)性紅斑狼瘡 1 例 ,中暑 1 例 ,腦血
管意外 1 例 ,肺癌術(shù)后 1 例 ......
李君君1
陳方平2
顏家運(yùn)1
余海仁1
顏向軍1
[摘要] 目的:探索彌散性血管內(nèi)凝血(DIC)早期診斷的實(shí)驗(yàn)指標(biāo)。方法:采用 EL ISA雙抗體夾心法測(cè)定血
漿凝血酶原片段 1 + 2 (F1 + 2) 、 D2二聚體(D2D) ,采用免疫濁度法測(cè)定血清抗凝血酶 Ⅲ(AT2Ⅲ) 。結(jié)果:各期 DIC
組患者血漿 F1 + 2、 D2D含量均顯著升高 ,AT2Ⅲ含量顯著降低 ,且與可疑 DIC組及正常對(duì)照組比較差異均有極顯
著性意義( P < 0. 01) 。在早期 DIC組中 ,F1 + 2陽性率為 100 % ,D2D 及 AT2Ⅲ陽性率為93. 8 % ,敏感性遠(yuǎn)遠(yuǎn)高于
DIC常規(guī)實(shí)驗(yàn)室檢查。結(jié)論:F1 + 2、 AT2Ⅲ、 D2D是能早期反映體內(nèi)凝血、抗凝及纖溶系統(tǒng)激活的敏感性指標(biāo)之一 ,在 DIC早期診斷中有著重要實(shí)用價(jià)值。
[關(guān)鍵詞] 血管內(nèi)凝血 ,彌散性;凝血酶原片段 1 + 2 ;抗凝血酶 Ⅲ;D2二聚體
[中圖分類號(hào)] R554 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 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
彌散性血管內(nèi)凝血(DIC)是發(fā)生于許多疾病
過程中的一種獲得性血栓2出血綜合征 ,其癥狀兇
險(xiǎn) ,進(jìn)展快速 ,如不及時(shí)診斷和處理 ,常常危及生
命。故當(dāng)有可能導(dǎo)致 DIC 的基礎(chǔ)疾病存在時(shí) ,早
期診斷、早期預(yù)防是 DIC 治療至關(guān)重要的環(huán)節(jié)。
本研究通過對(duì)血栓前狀態(tài)部分分子標(biāo)志物凝血酶
原片段 1 + 2 ( F1 + 2) 、 D2二聚體(D2D)及血清抗凝
血酶 Ⅲ(AT2Ⅲ)的定量檢測(cè) ,并與常規(guī)實(shí)驗(yàn)指標(biāo)比
較 ,以探討 3 種指標(biāo)在 DIC 早期診斷中的應(yīng)用價(jià)
值 ,為早期診斷和治療DIC提供新思路。
1 對(duì)象與方法
1. 1 研究對(duì)象
DIC患者的診斷依據(jù)為我國(guó)血栓與止血學(xué)術(shù)
會(huì)議制定的標(biāo)準(zhǔn)〔 1〕;可疑DIC患者均符合: ①存在
引起DIC的基礎(chǔ)疾病; ②具有一項(xiàng)以上 DIC 臨床
1
南華大學(xué)附屬第一醫(yī)院血液科(湖南衡陽 ,421001)
2
中南大學(xué)湘雅醫(yī)院血液科
表現(xiàn); ③ DIC常規(guī)檢查異常 ,但達(dá)不到診斷標(biāo)準(zhǔn)。
DIC組:35 例 ,男17 例 ,女18 例;年齡17~68
歲 ,平均41. 6歲。結(jié)合臨床病史、體征、實(shí)驗(yàn)室檢
測(cè)結(jié)果 ,根據(jù) DIC 病程將其再分為早期及中晚期
DIC兩組 ,其中重癥感染 11 例 ,產(chǎn)科疾病 8 例 ,急
性白血病 7 例(M34 例 ,M52 例 ,M21 例) ,惡性淋
巴瘤 2 例 ,惡性組織細(xì)胞病(簡(jiǎn)稱惡組) 2 例 ,前列
腺癌 1 例 ,系統(tǒng)性紅斑狼瘡 1 例 ,中暑 1 例 ,腦血
管意外 1 例 ,肺癌術(shù)后 1 例 ......
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