CAJ | 학술논문

目的评估弥漫性血管内凝血(DIC)评分对创伤性脑损伤患者(TBI)预后的预测作用. 方法收集2010年1月-2014年1月急诊入院的209例中、重度TBI[入院时格拉斯哥昏迷评分(GCS)3 ～ 12分]患者资料.根据国际血栓与止血学会颁布的DIC诊断标准(国际DIC评分)以及日本卫生部颁布的DIC诊断标准(日本DIC评分)对每位患者进行DIC评分,计算DIC评分预测进展性颅内出血(PHI)和预后的受试者工作特征(ROC)曲线下面积(AUC). 结果日本DIC评分AUC 95％ CI为0.847(0.795～0.898),对PHI预测能力显著高于其他单一凝血功能指标.而国际DIC评分和日本DIC评分对6个月死亡[AUC 95％ CI分别为0.734(0.644～0.824)和0.708(0.612 ～0.804)]和不良预后[AUC 95％ CI分别为0.640(0.566 ～0.714)和0.606(0.530～0.682)]的预测能力也较其他单项凝血功能指标高.将国际DIC评分和日本DIC评分分别加入死亡预测模型后,预测概率的AUC分别增加至0.811(95％CI0.741～0.880)和0.795 (95％ CI0.722～0.868). 结论 DIC评分对TBI患者PHI和预后的预测能力强于单一凝血功能指标,且将其纳入传统TBI预测指标可以增加对患者预后的预测能力.
목적 평고미만성혈관내응혈(DIC)평분대창상성뇌손상환자(TBI)예후적예측작용. 방법 수집2010년1월-2014년1월급진입원적209례중、중도TBI[입원시격랍사가혼미평분(GCS)3 ～ 12분]환자자료.근거국제혈전여지혈학회반포적DIC진단표준(국제DIC평분)이급일본위생부반포적DIC진단표준(일본DIC평분)대매위환자진행DIC평분,계산DIC평분예측진전성로내출혈(PHI)화예후적수시자공작특정(ROC)곡선하면적(AUC). 결과 일본DIC평분AUC 95％ CI위0.847(0.795～0.898),대PHI예측능력현저고우기타단일응혈공능지표.이국제DIC평분화일본DIC평분대6개월사망[AUC 95％ CI분별위0.734(0.644～0.824)화0.708(0.612 ～0.804)]화불량예후[AUC 95％ CI분별위0.640(0.566 ～0.714)화0.606(0.530～0.682)]적예측능력야교기타단항응혈공능지표고.장국제DIC평분화일본DIC평분분별가입사망예측모형후,예측개솔적AUC분별증가지0.811(95％CI0.741～0.880)화0.795 (95％ CI0.722～0.868). 결론 DIC평분대TBI환자PHI화예후적예측능력강우단일응혈공능지표,차장기납입전통TBI예측지표가이증가대환자예후적예측능력.
Objective To evaluate the role of disseminated intravascular coagulation (DIC) for prognosis prediction in patients with traumatic brain injury (TBI).Methods The retrospective review collected 209 patients with moderate to severe TBI (admission GCS score of 3-12 points) emergently admitted between January 2010 and January 2014.DIC score was calculated for each patient according to the modified diagnostic criteria for DIC by the International Society of Thrombosis and Hemostasis (international DIC score) and for DIC by the Japanese Ministry of Health and Welfare (Japanese DIC score) respectively.A receiver-operating characteristic (ROC) curve analysis based on the two DIC scores was made to calculate the area under curve (AUC) for prediction of progressive hemmorhage injury (PHI) and prognosis.Results AUC (95％ CI) of Japanese DIC score was 0.847 (0.795-0.898),indicating a higher predictive value of PHI over other single coagulation index.International DIC score and Japanese DIC score for 6-month mortality [AUC 0.734 (95％ CI 0.644-0.824) and AUC 0.708 (95％CI 0.612-0.804),respectively] and for 6-month unfavorable outcome [AUC 0.640 (95％ CI 0.566-0.714) and 0.606 (95％ CI 0.530-0.682),respectively] showed higher predictive value compared to other single coagulation index.When the international DIC score and Japanese DIC score were added into the predictive model of motality,the AUC were increased to 0.811 (95％ CI 0.741-0.880) and 0.795 (95％ CI 0.722-0.868) respectively.Conclusions Predictive value of DIC score for PHI and prognosis in TBI patients is higher than other single coagulation index.Combination of DIC score with traditional predictive model can increase the prediction ability on mortality of the TBI patients.