[血栓弹力图在儿童弥散性血管内凝血诊断中的作用]

[Effect of thrombelastography in the diagnosis of disseminated intravascular coagulation in children].

作者信息

Wang Yixue, Lu Guoping, Lu Zhujin, Zhang Lingen, Feng Zhimin

机构信息

Critical Care Department, Children's Hospital of Fudan University, Shanghai 201102, China.

Critical Care Department, Children's Hospital of Fudan University, Shanghai 201102, China. Email:

出版信息

Zhonghua Er Ke Za Zhi. 2014 Feb;52(2):128-32.

PMID:24739725

Abstract

OBJECTIVE

To study the effect of thrombelastography (TEM) in the diagnosis of disseminated intravascular coagulation (DIC) in children.

METHOD

The data of 117 children suffering from DIC in the pediatric intensive care unit (PICU) and Cardiologic ICU (CICU) in the authors' hospital from January 2010 to June 2012 were collected. Ninety-four children without DIC were enrolled into the control group. The platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimers and TEM were determined. The sensitivity and specificity of TEM were measured and the relevance of TEM and DIC was investigated to evaluate the effect of TEM and the conventional tests of the coagulation system in the diagnosis of DIC in children.

RESULT

The average R reaction time in the DIC group was significantly longer than that in the control group[(13.3 ± 3.3)s vs. (4.5 ± 2.6)s, P = 0.000 5], and the average α-angle in the DIC group was smaller than that in the control group significantly (37.2° ± 1.4° vs. 55.6° ± 3.8°, P = 0.001 0). There was significant decrease in the maximal amplitude (MA) and amplitude (A) in the DIC group, compared with the control group. The OR value (95%CI) of the R reaction time,α-angle and MA was 3.538 (1.298-5.389), 2.472 (1.820-2.224) and 0.256 (0.263-0.831) respectively, which suggests good correlation with the existence of DIC (all P < 0.01). The specificity of R reaction time, α-angle and MA was higher than that of PT, APTT and D-dimers (85.7%, 73.5% and 72.9% vs. 27.0%, 42.1% and 68.2%) . The average R reaction time of children suffering from hemorrhage of severe liver disease(n = 36) was significantly longer than that of 40 healthy children [(9.2 ± 2.7) vs. (2.3 ± 1.8)s, P = 0.001 0], while the α-angle (42.8° ± 7.6° vs. 59.2° ± 10.8°, P = 0.040 0) and the MA value [(33.9 ± 5.1) vs.(56.0 ± 8.1) mm, P = 0.020 0] were significantly smaller. The average R reaction time of children suffering from congenital coagulopathy was significantly longer than that of healthy children [(6.8 ± 3.1) vs. (2.3 ± 1.8)s, P = 0.003 0], too.

CONCLUSION

TEM, which has high specificity, is beneficial to the diagnosis of DIC in children.

摘要

目的

研究血栓弹力图（TEM）在儿童弥散性血管内凝血（DIC）诊断中的作用。

方法

收集2010年1月至2012年6月作者所在医院儿科重症监护病房（PICU）及心脏重症监护病房（CICU）117例DIC患儿的资料。选取94例非DIC患儿作为对照组。检测血小板计数、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D - 二聚体及TEM。测定TEM的敏感性和特异性，研究TEM与DIC的相关性，以评估TEM及传统凝血系统检测在儿童DIC诊断中的作用。

结果

DIC组平均R反应时间显著长于对照组[（13.3±3.3）秒对（4.5±2.6）秒，P = 0.000 5]，DIC组平均α角显著小于对照组（37.2°±1.4°对55.6°±3.8°，P = 0.001 0）。与对照组相比，DIC组最大振幅（MA）及振幅（A）显著降低。R反应时间、α角及MA的OR值（95%CI）分别为3.538（1.298 - 5.389）、2.472（1.820 - 2.224）及0.256（0.263 - 0.831），提示与DIC的存在有良好相关性（均P < 0.01）。R反应时间、α角及MA的特异性高于PT、APTT及D - 二聚体（85.7%、73.5%及72.9%对27.0%、42.1%及68.2%）。重症肝病出血患儿（n = 36）的平均R反应时间显著长于40例健康儿童[（9.2±2.7）对（2.3±1.8）秒，P = 0.001 0]，而α角（42.8°±7.6°对59.2°±10.8°，P = 0.040 0）及MA值[（33.9±5.1）对（56.0±8.1）毫米，P = 0.020 0]显著更小。先天性凝血障碍患儿的平均R反应时间也显著长于健康儿童[（6.8±3.1）对（2.3±1.8）秒，P = 0.003 0]。