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TAT、PIC、TM、t-PAIC四种分子标志物在弥散性血管内凝血早期诊断中的价值

The value of coagulation molecular markers TAT, PIC, TM and t-PAIC in early diagnosis of DIC

  • 摘要: 目的 探讨分子标志物凝血酶-抗凝血酶复合物(thrombin-antithrombin complex,TAT)、血栓调节蛋白(thrombomdulin,TM)、纤溶酶-α2纤溶酶抑制剂复合物(α2-plamininhibitor-plasmin complex,PIC)、组织型纤溶酶原激活剂-抑制剂复合物(tissue plaminogen antivator inhibitor complex,t-PAIC)在弥散性血管内凝血(disseminated intrascular coagulation,DIC)中的早期诊断价值.方法 纳入233例有出血倾向或血栓患者的临床病例资料,根据2017年版中国DIC诊断积分系统(CDSS),分为显性DIC组、前DIC组和非DIC组,采用新的自动化技术检测实验室指标,包括TAT、TM、PIC、t-PAIC,比较各组间实验室指标的差异,评估其在DIC早期诊断中的价值.结果 在显性DIC患者中,TAT、TM、PIC水平显著高于非DIC患者,t-PAIC在两组中无统计学意义;在前DIC患者中,TAT、TM、PIC、t-PAIC水平显著高于非DIC患者;ROC曲线显示,TAT、TM、PIC及t-PAIC联合诊断曲线下面积为0.887,联合凝血酶原时间(prothomin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、D-二聚体(D-dimer ,D-D)可达最大曲线下面积为0.933.结论 TAT、TM、PIC及t-PAIC联合检测可提高DIC早期诊断率,为临床早期干预和治疗提供最佳时机.

     

    Abstract: Objective To explore the clinical significance of thrombin molecular marker in disseminated intrascular coagulation (DIC), which include thrombin-antithrombin complex (TAT), thrombomodulin (TM), plasmin-antiplasmin inhibitor complex (α2-plamininhibitor-plasmin complex,PIC) and tissue plasminogen activator inhibitor complex (t-PAIC) .Methods This study included 233 patients with bleeding tendency or thrombosis, according to the 2017 edition of the Chinese disseminated intravascular coagulation diagnostic score system (CDSS),who were divided into the dominant DIC group, pre-DIC group and non-DIC group. The differences in laboratory indicators between groups were compared, and its value in the early diagnosis of DIC was evaluated.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 development of overt-DIC.Results In patients with overt-DIC, TAT, TM, PIC were significantly higher than those in non-DIC patients, and t-PAIC was statistically insignificant between the overt-DIC and non-DIC groups. TAT, TM, PIC, t-PAIC levels were significantly higher in patients with pre-DIC than in non-DIC patients.The AUC shows that the combined diagnostic curve of TAT, TM, PIC, and t-PAIC is 0.887,and AUC combined PT, APTT, and D-D is 0.933.Conclusions The combination of TAT, TM, PIC and t-PAIC can improve the early diagnosis rate of DIC and provide optimal timing for early clinical intervention and treatment.

     

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