Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Hubei Clinical and Research Center of Thrombosis and Hemostasis, Wuhan, 430022, China.
Curr Med Sci. 2019 Aug;39(4):546-550. doi: 10.1007/s11596-019-2072-9. Epub 2019 Jul 25.
In this study, we used plasma factor V activity and parameters of the thrombin generation test to discuss their diagnostic and prognostic value for disseminated intravascular coagulation (DIC) in patients with hematological malignancies. A total of 164 patients who were diagnosed with hematological malignancies in the Department of Hematology, Union Hospital, between Apr. 2014 and Dec. 2014 were enrolled in this study. There were 131 patients in the study group and 33 patients in the control group in terms of the laboratory results for DIC. The patients in the study group were divided into a DIC subgroup (n=59) and a non-DIC subgroup (n=72) based on the International Society of Thrombosis and Hemostasis (ISTH) Integral System, and they were divided into four subgroups [score ≤3 (n=35), score=4 (n=37), score=5 (n=47), and score ≥6 (n=12)] according to ISTH scores. Using 28-day mortality as the endpoint, the patients in the study group were divided into a survival subgroup (n=111) and a non-survival subgroup (n=20). The results showed that the plasma factor V activity was significantly weaker, and lag time and time to peak were significantly shorter in the study group than in the control group (P<0.01). The factor V activity, peak and endogenous thrombin potential (ETP) were significantly decreased in the DIC subgroup as compared with those in the non-DIC subgroup (P<0.01). Among factor V activity, lag time, peak, ETP, and ttPeak, only the factor V activity was significantly decreased in the non-survival subgroup compared with the survival subgroup (P<0.01). With the increase in ISTH score, the ETP and peak decreased gradually. The binary logistic regression analysis revealed that PLT, D-dimer, factor V activity and ETP had linear relationship with DIC diagnosed by ISTH Integral System. Using DIC diagnosed by ISTH Integral System as the endpoint, the area under curve (AUC) of factor V activity was found to be similar to that of blood platelet count (PLT) and prothrombin time (PT). In conclusion, factor V activity, ETP and peak had diagnostic value for DIC in patients with hematological malignancies, and only factor V activity had limited prognostic value.
在这项研究中，我们使用血浆因子 V 活性和凝血酶生成试验参数来探讨它们在血液病患者弥漫性血管内凝血 (DIC) 中的诊断和预后价值。共有 164 例在 2014 年 4 月至 2014 年 12 月在我院血液科诊断为血液病的患者被纳入本研究。根据 DIC 的实验室结果，研究组中有 131 例患者，对照组中有 33 例患者。根据国际血栓与止血学会（ISTH）积分系统，研究组患者分为 DIC 亚组（n=59）和非 DIC 亚组（n=72），根据 ISTH 评分分为四个亚组[评分≤3（n=35），评分=4（n=37），评分=5（n=47），评分≥6（n=12）]。以 28 天死亡率为终点，将研究组患者分为存活亚组（n=111）和非存活亚组（n=20）。结果显示，研究组患者的血浆因子 V 活性明显减弱，而凝血酶原时间和凝血酶峰值时间明显缩短（P<0.01）。与非 DIC 亚组相比，DIC 亚组的因子 V 活性、凝血酶峰值和内源性凝血酶潜能（ETP）明显降低（P<0.01）。在因子 V 活性、凝血酶原时间、凝血酶峰值、ETP 和 ttPeak 中，只有非存活亚组的因子 V 活性与存活亚组相比明显降低（P<0.01）。随着 ISTH 评分的增加，ETP 和凝血酶峰值逐渐降低。二元逻辑回归分析表明，PLT、D-二聚体、因子 V 活性和 ETP 与 ISTH 积分系统诊断的 DIC 呈线性关系。以 ISTH 积分系统诊断的 DIC 为终点，因子 V 活性的曲线下面积（AUC）与血小板计数（PLT）和凝血酶原时间（PT）相似。总之，因子 V 活性、ETP 和凝血酶峰值对血液病患者 DIC 具有诊断价值，只有因子 V 活性具有有限的预后价值。
