Yu M, Nardella A, Pechet L
Department of Pathology, University of Massachusetts Memorial Health Care, Worcester, USA.
Crit Care Med. 2000 Jun;28(6):1777-80. doi: 10.1097/00003246-200006000-00013.
To study the clinician's ordering pattern in the diagnosis of disseminated intravascular coagulation (DIC) and to analyze the utility of selected tests by assessing their sensitivity, specificity, and overall efficiency.
Retrospective, nonrandomized, clinical study.
University hospital intensive care units.
A total of 82 inpatients treated in our intensive care units were identified from the hospital computer system as having been tested for DIC in a 3-month period.
Screening tests for DIC were ordered for the suspected patients.
Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen/fibrin degradation products (FDP), and fibrinogen were used most frequently as DIC diagnostic tests. The FDP and D-dimer combination (n = 39) had the highest diagnostic efficiency of 95%, with sensitivity being 91% and specificity 94%. This is followed by FDP (n = 71), efficiency 87%, sensitivity 100%, and specificity 67%; PT/PTT and FDP combination (n = 71), efficiency 86%, sensitivity 91%, and specificity 71%; and D-dimer (n = 44), efficiency 80%, sensitivity 91%, and specificity 68%. The rest of the commonly used tests, such as PT, PTT, thrombin time, platelet count, fibrinogen, and the presence of schistocytes (n = 80), had individually either low specificity or low sensitivity and, therefore, low efficiency scores (57%, 57%, 70%, 67%, 65%, and 51%, respectively).
The D-dimer and FDP tests offered the best test panel in the diagnosis of DIC. We propose the use of D-dimer, FDP, and antithrombin as the DIC diagnostic test panel, with D-dimer and FDP providing a rapid and specific diagnosis, antithrombin providing insight to the severity and prognosis, and FDP (rapid and less expensive than D-dimer) to follow-up the progress of the condition once the diagnosis is established.
研究临床医生在弥散性血管内凝血（DIC）诊断中的检验申请模式，并通过评估所选检验的敏感性、特异性和总体效率来分析其效用。
回顾性、非随机临床研究。
大学医院重症监护病房。
从医院计算机系统中确定，共有82名在我们重症监护病房接受治疗的住院患者在3个月内接受了DIC检测。
为疑似患者开具DIC筛查检验。
凝血酶原时间（PT）、活化部分凝血活酶时间（PTT）、纤维蛋白原/纤维蛋白降解产物（FDP）和纤维蛋白原是最常作为DIC诊断检验的项目。FDP和D-二聚体联合检测（n = 39）的诊断效率最高，为95%，敏感性为91%，特异性为94%。其次是FDP（n = 71），效率为87%，敏感性为100%，特异性为67%；PT/PTT与FDP联合检测（n = 71），效率为86%，敏感性为91%，特异性为71%；以及D-二聚体（n = 44），效率为80%，敏感性为91%，特异性为68%。其余常用检验，如PT、PTT、凝血酶时间、血小板计数、纤维蛋白原和裂体细胞的存在情况（n = 80），单独来看要么特异性低，要么敏感性低，因此效率得分也低（分别为57%、57%、70%、67%、65%和51%）。
D-二聚体和FDP检测在DIC诊断中提供了最佳的检验组合。我们建议使用D-二聚体、FDP和抗凝血酶作为DIC诊断检验组合，其中D-二聚体和FDP可提供快速且特异的诊断，抗凝血酶可洞察病情的严重程度和预后，而FDP（比D-二聚体快速且成本低）可在确诊后用于跟踪病情进展。
