Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China; Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
Department of Hematology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
Thromb Res. 2019 Jan;173:20-26. doi: 10.1016/j.thromres.2018.11.010. Epub 2018 Nov 13.
Accurate and early diagnosis is important in the management of disseminated intravascular coagulation (DIC). We employed new automation technology to detect plasma biomarkers, including thrombin-antithrombin complex (TAT), α2-plasmininhibitor-plasmin complex (PIC), soluble thrombomodulin (sTM), and tissue plasminogen activator-inhibitor complex (tPAIC), and evaluated their diagnostic performance and prognostic value for DIC in Chinese population.
This prospective observational study included 444 patients with suspected DIC and 137 healthy people. The molecular markers were measured by qualitative chemiluminescence enzyme immunoassay performed on HISCL automated analyzers. All patients with suspected DIC were followed for 7 days to screen for the development of overt-DIC and 28 days for mortality.
According to the International Society of Thrombosis and Haemostasis (ISTH) scoring system, 157 patients were diagnosed as overt-DIC and 36 were diagnosed as pre-DIC. All four biomarkers were significantly higher in DIC patients than in non-overt DIC patients; TAT, tPAIC, and sTM were significantly higher in pre-DIC patients than in non-overt DIC patients. Four molecular markers behaved differently among various underlying diseases. TAT, tPAIC, and sTM were also good predictors of 28-day mortality, high levels were associated with poor outcomes.
TAT, PIC, tPAIC, and sTM demonstrated good diagnostic performance and prognostic value in DIC patients with different underlying diseases. Besides, TAT, tPAIC and sTM have certain implications in pre-DIC stage. Combination of four makers was demonstrated better behavior than single one.
准确和早期诊断对于弥散性血管内凝血（DIC）的治疗非常重要。我们采用新的自动化技术检测血浆生物标志物，包括凝血酶-抗凝血酶复合物（TAT）、α2-纤溶酶抑制剂-纤溶酶复合物（PIC）、可溶性血栓调节蛋白（sTM）和组织型纤溶酶原激活物抑制剂复合物（tPAIC），并评估它们在中国人群中对 DIC 的诊断性能和预后价值。
本前瞻性观察性研究纳入了 444 例疑似 DIC 患者和 137 例健康人。采用 HISCL 自动化分析仪进行定性化学发光酶免疫分析检测分子标志物。所有疑似 DIC 患者均随访 7 天以筛查显性 DIC 发生，随访 28 天以筛查死亡率。
根据国际血栓与止血学会（ISTH）评分系统，157 例患者被诊断为显性 DIC，36 例被诊断为预显性 DIC。所有 4 种生物标志物在 DIC 患者中的水平均明显高于非显性 DIC 患者；TAT、tPAIC 和 sTM 在预显性 DIC 患者中的水平明显高于非显性 DIC 患者。4 种分子标志物在不同基础疾病中表现不同。TAT、tPAIC 和 sTM 也是 28 天死亡率的良好预测指标，高水平与不良结局相关。
TAT、PIC、tPAIC 和 sTM 在不同基础疾病的 DIC 患者中表现出良好的诊断性能和预后价值。此外，TAT、tPAIC 和 sTM 在预显性 DIC 阶段具有一定意义。与单一标志物相比，联合检测 4 种标志物的表现更好。
