Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Blood Coagul Fibrinolysis. 2021 Jun 1;32(4):248-252. doi: 10.1097/MBC.0000000000001025.
Early diagnosis of disseminated intravascular coagulation (DIC) before its progression to an overt stage is beneficial for its treatment and prognosis.This retrospective study aimed to evaluate the diagnostic performance of D-dimer and fibrin monomer in the early stage of DIC.A total of 707 patients suspected of having DIC, 302 healthy people were enrolled and divided into four groups: overt DIC, nonovert DIC, non-DIC based on the International Society of Thrombosis and Hemostasis scoring for overt DIC and the modified nonovert DIC criteria, healthy people as control group. Quantitative determination was done by immunoturbidimetry for D-dimer and fibrin monomer.The median of fibrin monomer in overt, nonovert and non-DIC was 41.65, 26.89 and 8.68 μg/ml, respectively. The median of D-dimer in overt, nonovert and non-DIC was 9.69, 3.98 and 3.08 μg/ml, respectively. D-dimer and fibrin monomer values were higher in overt DIC than other groups, but there was no difference between nonovert DIC and non-DIC in D-dimer. Unlike D-dimer, statistically significant differences were found in fibrin monomer between nonovert and non-DIC. At receiver operator characteristic curve-generated cutoff values, fibrin monomer had much excellent predictive performance compared with D-dimer for distinguishing nonovert DIC from non-DIC. D-dimer and fibrin monomer had same diagnostic performance in distinguishing overt DIC from non-DIC.Fibrin monomer is a better indicator compared with D-dimer in distinguishing patients with nonovert DIC from non-DIC. Hence, it might serve as an excellent negative exclusion marker to provide a reference for early clinical diagnosis and intervention through more studies.
早期诊断弥漫性血管内凝血（DIC），使其在明显阶段之前得到治疗和改善预后是有益的。本回顾性研究旨在评估 D-二聚体和纤维蛋白单体在 DIC 早期阶段的诊断性能。共纳入 707 例疑似 DIC 患者和 302 例健康人，分为显性 DIC、非显性 DIC、非 DIC（基于国际血栓与止血学会显性 DIC 评分标准和改良非显性 DIC 标准）和健康对照组。用免疫比浊法定量测定 D-二聚体和纤维蛋白单体。显性 DIC、非显性 DIC 和非 DIC 组纤维蛋白单体中位数分别为 41.65、26.89 和 8.68μg/ml，显性 DIC、非显性 DIC 和非 DIC 组 D-二聚体中位数分别为 9.69、3.98 和 3.08μg/ml。显性 DIC 组的 D-二聚体和纤维蛋白单体值均高于其他组，但非显性 DIC 组与非 DIC 组的 D-二聚体值无差异。与 D-二聚体不同，非显性 DIC 组与非 DIC 组的纤维蛋白单体值有统计学差异。在受试者工作特征曲线生成的截断值时，纤维蛋白单体在区分非显性 DIC 与非 DIC 方面比 D-二聚体具有更好的预测性能。D-二聚体和纤维蛋白单体在区分显性 DIC 与非 DIC 方面具有相同的诊断性能。纤维蛋白单体在区分非显性 DIC 与非 DIC 方面比 D-二聚体更好。因此，通过更多研究，它可能作为一个极好的阴性排除标志物，为早期临床诊断和干预提供参考。
