Choi Qute, Hong Ki Ho, Kim Ji-Eun, Kim Hyun Kyung
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Laboratory Medicine, Seoul Medical Center, Seoul, Korea.
Ann Lab Med. 2014 Mar;34(2):85-91. doi: 10.3343/alm.2014.34.2.85. Epub 2014 Feb 13.
Dysfunctional natural anticoagulant systems enhance intravascular fibrin formation in disseminated intravascular coagulation (DIC), and plasma levels of natural anti coagulants can be used in the diagnosis and prognosis of DIC. Herein, the diagnostic value of 4 natural anticoagulants was assessed, and the prognostic value of antithrombin and protein C were validated in a large population.
Part 1 study included 126 patients with clinically suspected DIC and estimated plasma levels of 4 candidate anticoagulant proteins: antithrombin, protein C, protein S, and protein Z. Part 2 comprised 1,846 patients, in whom plasma antithrombin and protein C levels were compared with other well-known DIC markers according to the underlying dis eases. The 28-day mortality rate was used to assess prognostic outcome.
Antithrombin and protein C showed higher areas under the ROC curve than protein S and protein Z. In part 2 of the study, antithrombin and protein C levels significantly correlated with DIC score, suggesting that these factors are good indicators of DIC severity. Antithrombin and protein C showed significant prognostic power in Kaplan-Meier analyses. In patients with sepsis/severe infection, antithrombin and protein C showed higher hazard ratios than D-dimer. Platelet count showed the highest hazard ratio in patients with hemato logic malignancy. In patients with liver disease, the hazard ratio for antithrombin levels was significantly high.
Decreased plasma anticoagulant levels reflect florid consumption of the physiologic defense system against DIC-induced hypercoagulation. Plasma antithrombin and protein C levels are powerful prognostic markers of DIC, especially in patients with sepsis/severe infection.
功能失调的天然抗凝系统会增强弥散性血管内凝血（DIC）时的血管内纤维蛋白形成，天然抗凝剂的血浆水平可用于DIC的诊断和预后评估。在此，评估了4种天然抗凝剂的诊断价值，并在大量人群中验证了抗凝血酶和蛋白C的预后价值。
第1部分研究纳入了126例临床疑似DIC的患者，并测定了4种候选抗凝蛋白的血浆水平：抗凝血酶、蛋白C、蛋白S和蛋白Z。第2部分包括1846例患者，根据潜在疾病将其血浆抗凝血酶和蛋白C水平与其他知名的DIC标志物进行比较。采用28天死亡率评估预后结果。
抗凝血酶和蛋白C的ROC曲线下面积高于蛋白S和蛋白Z。在研究的第2部分中，抗凝血酶和蛋白C水平与DIC评分显著相关，表明这些因素是DIC严重程度的良好指标。在Kaplan-Meier分析中，抗凝血酶和蛋白C显示出显著的预后能力。在脓毒症/严重感染患者中，抗凝血酶和蛋白C的风险比高于D-二聚体。血小板计数在血液系统恶性肿瘤患者中显示出最高的风险比。在肝病患者中，抗凝血酶水平的风险比显著升高。
血浆抗凝剂水平降低反映了针对DIC诱导的高凝状态的生理防御系统的大量消耗。血浆抗凝血酶和蛋白C水平是DIC的有力预后标志物，尤其是在脓毒症/严重感染患者中。
