Hayakawa Mineji, Gando Satoshi, Hoshino Hirokatsu
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
Clin Appl Thromb Hemost. 2007 Jan;13(1):65-72. doi: 10.1177/1076029606296405.
Clinical and laboratory criteria and a scoring system for disseminated intravascular coagulation (DIC) were recently published by the International Society on Thrombosis and Haemostasis (ISTH). In Japan, the DIC Diagnostic Standards published in 1988 have been widely used for more than 10 years. In a general intensive care unit, we prospectively compared the diagnostic properties of the overt DIC, nonovert DIC, and Japanese DIC criteria sets, and investigated the influences of each set on patient morbidity and mortality. Seventy-four patients with platelet counts below 150 x 10(9)/L were included in this study. Blood samples were collected daily from day 0 to day 4 after inclusion in the study. The Japanese DIC included the overt DIC and both of these were included in the nonovert DIC. The Japanese DIC criteria diagnosed DIC earlier than the nonovert DIC criteria did (P = .020). The DIC patients diagnosed by the Japanese criteria and those diagnosed by the overt DIC criteria showed a higher incidence of multiple organ failure than those without DIC (P = .013 and P = .022, respectively). The Japanese and the nonovert DIC criteria tended to predict patient prognoses effectively. In conclusion, the Japanese and the nonovert DIC criteria are of value in predicting outcome. However, the nonovert DIC criteria take more time to diagnose DIC than the Japanese criteria do. A more precise clinical study is needed to determined appropriate specific criteria and cutoff points in the nonovert DIC criteria set.
国际血栓与止血学会（ISTH）最近发布了弥散性血管内凝血（DIC）的临床和实验室标准以及评分系统。在日本，1988年发布的DIC诊断标准已被广泛使用了10多年。在一个普通重症监护病房，我们前瞻性地比较了显性DIC、非显性DIC和日本DIC标准集的诊断特性，并研究了每组标准对患者发病率和死亡率的影响。本研究纳入了74例血小板计数低于150×10⁹/L的患者。从纳入研究后的第0天到第4天每天采集血样。日本DIC包括显性DIC，且这两者都包含在非显性DIC中。日本DIC标准比非显性DIC标准更早诊断出DIC（P = 0.020）。根据日本标准诊断为DIC的患者和根据显性DIC标准诊断为DIC的患者，其多器官功能衰竭的发生率高于未发生DIC的患者（分别为P = 0.013和P = 0.022）。日本和非显性DIC标准倾向于有效地预测患者预后。总之，日本和非显性DIC标准在预测预后方面具有价值。然而，非显性DIC标准诊断DIC比日本标准花费的时间更多。需要进行更精确的临床研究来确定非显性DIC标准集中合适的具体标准和临界值。
