中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
2期
128-132
,共5页
王一雪%陆国平%陆铸今%张灵恩%冯志敏
王一雪%陸國平%陸鑄今%張靈恩%馮誌敏
왕일설%륙국평%륙주금%장령은%풍지민
血栓弹力描记术%弥漫性血管内凝血%重症监护病房%敏感性与特异性
血栓彈力描記術%瀰漫性血管內凝血%重癥鑑護病房%敏感性與特異性
혈전탄력묘기술%미만성혈관내응혈%중증감호병방%민감성여특이성
Thrombelastography%Disseminated intravascular coagulation%Intensive care unit%Sensitivity and specificity
目的 了解血栓弹力图检查对弥散性血管内凝血(DIC)患儿的诊断价值.方法 收集2010年1月至2012年6月入住复旦大学附属儿科医院儿童重症监护室和心脏重症监护室的DIC患儿117例,同时选取非DIC组94例(包括临床上易与DIC混淆的疾病如重症肝病出血、先天性凝血功能紊乱等以及健康儿童).DIC组和非DIC组均测血小板计数、常规凝血功能四项、D-二聚体和血栓弹力图.计算血栓弹力图各指标R时间、α角、MA、A值的敏感度和特异度,研究血栓弹力图各指标与发生DIC的相关性,比较血栓弹力图和常规凝血功能检测对DIC的诊断作用.结果 DIC组的平均R时间显著长于非DIC组[(13.3±3.3)比(4.5 ±2.6)s,P=0.000 5],DIC组的平均α角明显小于非DIC组(37.2°±1.4°比55.6°±3.8°,P=0.001 0).DIC组的MA值和A值也均小于非DIC组(均P ＜0.01).其中R时间、α角和MA值的OR值(95％Cl)分别为3.538(1.298 ～5.389),2.472(1.820 ～2.224)和0.256(0.263 ～0.831)(均P＜0.01).R时间、α角和MA值诊断DIC的特异度分别为85.7％、73.5％和72.9％,显著高于常规凝血功能检测的指标[血浆凝血酶原时间、活化的部分凝血活酶时间、国际标准化比值、纤维蛋白原、血浆纤维蛋白(原)降解产物、D-二聚体诊断DIC的特异度分别为27.0％、42.1％、47.8％、43.3％、42.6％和68.2％].36例重症肝病出血患儿平均R时间明显长于40名健康儿童[(9.2±2.7)比(2.3±1.8)s,P=0.001 0],α角和MA值均明显小于健康儿童[42.8°±7.6°比59.2°±10.8°,(33.9±5.1)比(56.0±8.1)mm,P=0.040 0、0.020 0],两组A值差异无统计学意义(P＞0.05);11例先天性凝血功能紊乱患儿平均R时间较健康儿童显著长[(6.8±3.1)比(2.3±1.8)s,P=0.003 0],两组α角、MA值和A值差异均无统计学意义(均P＞0.05).结论 儿童DIC发生时,血栓弹力图各指标均有显著变化,包括R时间的延长,α角、MA值和A值的减小.相对常规凝血功能检测,其诊断DIC的特异度较高,能发挥良好的诊断作用,可补充常规凝血功能的不足,早期发现DIC,降低DIC的病死率.
目的 瞭解血栓彈力圖檢查對瀰散性血管內凝血(DIC)患兒的診斷價值.方法 收集2010年1月至2012年6月入住複旦大學附屬兒科醫院兒童重癥鑑護室和心髒重癥鑑護室的DIC患兒117例,同時選取非DIC組94例(包括臨床上易與DIC混淆的疾病如重癥肝病齣血、先天性凝血功能紊亂等以及健康兒童).DIC組和非DIC組均測血小闆計數、常規凝血功能四項、D-二聚體和血栓彈力圖.計算血栓彈力圖各指標R時間、α角、MA、A值的敏感度和特異度,研究血栓彈力圖各指標與髮生DIC的相關性,比較血栓彈力圖和常規凝血功能檢測對DIC的診斷作用.結果 DIC組的平均R時間顯著長于非DIC組[(13.3±3.3)比(4.5 ±2.6)s,P=0.000 5],DIC組的平均α角明顯小于非DIC組(37.2°±1.4°比55.6°±3.8°,P=0.001 0).DIC組的MA值和A值也均小于非DIC組(均P ＜0.01).其中R時間、α角和MA值的OR值(95％Cl)分彆為3.538(1.298 ～5.389),2.472(1.820 ～2.224)和0.256(0.263 ～0.831)(均P＜0.01).R時間、α角和MA值診斷DIC的特異度分彆為85.7％、73.5％和72.9％,顯著高于常規凝血功能檢測的指標[血漿凝血酶原時間、活化的部分凝血活酶時間、國際標準化比值、纖維蛋白原、血漿纖維蛋白(原)降解產物、D-二聚體診斷DIC的特異度分彆為27.0％、42.1％、47.8％、43.3％、42.6％和68.2％].36例重癥肝病齣血患兒平均R時間明顯長于40名健康兒童[(9.2±2.7)比(2.3±1.8)s,P=0.001 0],α角和MA值均明顯小于健康兒童[42.8°±7.6°比59.2°±10.8°,(33.9±5.1)比(56.0±8.1)mm,P=0.040 0、0.020 0],兩組A值差異無統計學意義(P＞0.05);11例先天性凝血功能紊亂患兒平均R時間較健康兒童顯著長[(6.8±3.1)比(2.3±1.8)s,P=0.003 0],兩組α角、MA值和A值差異均無統計學意義(均P＞0.05).結論 兒童DIC髮生時,血栓彈力圖各指標均有顯著變化,包括R時間的延長,α角、MA值和A值的減小.相對常規凝血功能檢測,其診斷DIC的特異度較高,能髮揮良好的診斷作用,可補充常規凝血功能的不足,早期髮現DIC,降低DIC的病死率.
목적 료해혈전탄력도검사대미산성혈관내응혈(DIC)환인적진단개치.방법 수집2010년1월지2012년6월입주복단대학부속인과의원인동중증감호실화심장중증감호실적DIC환인117례,동시선취비DIC조94례(포괄림상상역여DIC혼효적질병여중증간병출혈、선천성응혈공능문란등이급건강인동).DIC조화비DIC조균측혈소판계수、상규응혈공능사항、D-이취체화혈전탄력도.계산혈전탄력도각지표R시간、α각、MA、A치적민감도화특이도,연구혈전탄력도각지표여발생DIC적상관성,비교혈전탄력도화상규응혈공능검측대DIC적진단작용.결과 DIC조적평균R시간현저장우비DIC조[(13.3±3.3)비(4.5 ±2.6)s,P=0.000 5],DIC조적평균α각명현소우비DIC조(37.2°±1.4°비55.6°±3.8°,P=0.001 0).DIC조적MA치화A치야균소우비DIC조(균P ＜0.01).기중R시간、α각화MA치적OR치(95％Cl)분별위3.538(1.298 ～5.389),2.472(1.820 ～2.224)화0.256(0.263 ～0.831)(균P＜0.01).R시간、α각화MA치진단DIC적특이도분별위85.7％、73.5％화72.9％,현저고우상규응혈공능검측적지표[혈장응혈매원시간、활화적부분응혈활매시간、국제표준화비치、섬유단백원、혈장섬유단백(원)강해산물、D-이취체진단DIC적특이도분별위27.0％、42.1％、47.8％、43.3％、42.6％화68.2％].36례중증간병출혈환인평균R시간명현장우40명건강인동[(9.2±2.7)비(2.3±1.8)s,P=0.001 0],α각화MA치균명현소우건강인동[42.8°±7.6°비59.2°±10.8°,(33.9±5.1)비(56.0±8.1)mm,P=0.040 0、0.020 0],량조A치차이무통계학의의(P＞0.05);11례선천성응혈공능문란환인평균R시간교건강인동현저장[(6.8±3.1)비(2.3±1.8)s,P=0.003 0],량조α각、MA치화A치차이균무통계학의의(균P＞0.05).결론 인동DIC발생시,혈전탄력도각지표균유현저변화,포괄R시간적연장,α각、MA치화A치적감소.상대상규응혈공능검측,기진단DIC적특이도교고,능발휘량호적진단작용,가보충상규응혈공능적불족,조기발현DIC,강저DIC적병사솔.
Objective To study the effect of thrombelastography (TEM) in the diagnosis of disseminated intravascular coagulation (DIC) in children.Method The data of 117 children suffering from DIC in the pediatric intensive care unit (PICU) and Cardiologic ICU (CICU) in the authors' hospital from January 2010 to June 2012 were collected.Ninety-four children without DIC were enrolled into the control group.The platelet count,prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB),D-dimers and TEM were determined.The sensitivity and specificity of TEM were measured and the relevance of TEM and DIC was investigated to evaluate the effect of TEM and the conventional tests of the coagulation system in the diagnosis of DIC in children.Result The average R reaction time in the DIC group was significantly longer than that in the control group[(13.3 ± 3.3)s vs.(4.5 ±2.6)s,P =0.000 5],and the average α-angle in the DIC group was smaller than that in the control group significantly (37.2° ± 1.4° vs.55.6° ± 3.8°,P =0.001 0).There was significant decrease in the maximal amplitude (MA) and amplitude (A) in the DIC group,compared with the control group.The OR value(95％ Cl) of the R reaction time,α-angle and MA was 3.538 (1.298-5.389),2.472 (1.820-2.224) and 0.256 (0.263-0.831) respectively,which suggests good correlation with the existence of DIC (all P ＜ 0.01).The specificity of R reaction time,α-angle and MA was higher than that of PT,APTT and D-dimers(85.7％,73.5％ and 72.9％ vs.27.0％,42.1％ and 68.2％).The average R reaction time of children suffering from hemorrhage of severe liver disease (n =36) was significantly longer than that of 40 healthy children [(9.2 ± 2.7) vs.(2.3 ± 1.8) s,P =0.001 0],while the α-angle (42.8° ± 7.6° vs.59.2° ± 10.8°,P =0.040 0) and the MA value [(33.9 ±5.1) vs.(56.0 ± 8.1) mm,P =0.020 0] were significantly smaller.The average R reaction time of children suffering from congenital coagulopathy was significantly longer than that of healthy children [(6.8 ± 3.1) vs.(2.3 ± 1.8) s,P =0.003 0],too.Conclusion TEM,which has high specificity,is beneficial to the diagnosis of DIC in children.
