Wada Hideo
Department of Laboratory Medicine, Mie University School of Medicine, Tsu 514-8507.
Rinsho Byori. 2002 Aug;50(8):768-72.
There are global coagulation tests and hemostatic molecular markers in the diagnosis of disseminated intravascular coagulation (DIC). In the global coagulation tests, the sensitivity of prothrombin time ratio and fibrinogen for the diagnosis of DIC is low, but their specificity is high. In platelet count and FDP, the sensitivity for the diagnosis of DIC is good, but the specificity is low. Fibrinogen may be unsuitable for the diagnosis of DIC, because it increases of the inflammatory reaction. It is possible to theoretically diagnose DIC by increased tissue factor production. It is currently considered that hemostatic molecular marker should be utilized to diagnose DIC. Thrombin-antithrombin complex and soluble fibrin are reflected to hypercoagulable state, thrombomodulin to vascular endothelial cell injuries, and plasminogen activator inhibitor-I to hypofibrinolytic state. In leukemia with DIC, hyperfibrinolysis and marked bleeding symptoms are often observed. In septicemia with DIC, hypofibrinolysis and severe organ failure often occur. Early diagnosis and treatment of DIC are important to improve the prognosis, and hemostatic molecular markers should be useful for that purpose.
在弥散性血管内凝血(DIC)的诊断中有全身性凝血试验和止血分子标志物。在全身性凝血试验中,凝血酶原时间比值和纤维蛋白原对DIC诊断的敏感性较低,但其特异性较高。在血小板计数和纤维蛋白降解产物(FDP)方面,对DIC诊断的敏感性较好,但特异性较低。纤维蛋白原可能不适用于DIC的诊断,因为它会因炎症反应而升高。理论上,可通过组织因子产生增加来诊断DIC。目前认为应利用止血分子标志物来诊断DIC。凝血酶 - 抗凝血酶复合物和可溶性纤维蛋白反映高凝状态,血栓调节蛋白反映血管内皮细胞损伤,纤溶酶原激活物抑制剂 - Ⅰ反映低纤溶状态。在伴有DIC的白血病中,常观察到纤溶亢进和明显的出血症状。在伴有DIC的败血症中,常发生低纤溶和严重器官衰竭。DIC的早期诊断和治疗对改善预后很重要,止血分子标志物应有助于实现这一目的。