摘要
目的探讨肿瘤合并弥散性血管内凝血(DIC)与非肿瘤疾病合并DIC在临床表现、实验室指标方面的差异和特征。方法应用2017新版中国弥散性血管内凝血诊断积分系统(CDSS)诊断标准对玉溪市人民医院2012年1月至2018年12月疑诊肿瘤合并DIC与非肿瘤疾病合并DIC患者进行诊断并对两组间的临床表现、实验室指标的差异及特点进行比较和分析。结果 (1)206例疑诊DIC患者经新CDSS诊断,肿瘤合并DIC49例,占69.01%,高于非肿瘤疾病合并DIC的35例(25.93%),差异有统计学意义(P<0.001);诊断DIC(+)者的28d病死率为79.76%,高于DIC(-)者的64.75%,差异有统计学意义(P<0.05)。(2)出血及严重出血(2级出血)发生率:非肿瘤疾病合并DIC组出血发生率高于肿瘤合并DIC组(P<0.05),2级出血发生率(57.14%)则低于肿瘤合并DIC组(59.18%),但差异无统计学意义(P>0.05);出血部位:肿瘤合并DIC组以皮肤、黏膜瘀点、瘀斑及消化道出血多见,非肿瘤疾病合并DIC组以泌尿系统和消化道出血多见。(3)实验室指标:肿瘤DIC(+)组血小板计数<50×10^9/L者所占比例高于非肿瘤疾病DIC(+)组(P<0.01);肿瘤合并DIC组白细胞计数高于非肿瘤疾病合并DIC组(P<0.05);肿瘤合并DIC组血小板计数减少比非肿瘤疾病合并DIC组明显(P<0.05);非肿瘤疾病合并DIC组活化部分凝血活酶时间(APTT)延长比肿瘤合并DIC组明显(P<0.01)。凝血酶原时间(PT)、纤维蛋白原(FIB)及D-二聚体(D-D)水平两组间比较差异无统计学意义(P>0.05)。结论 2017新版CDSS可提高对DIC的诊断准确率,对两类疾病DIC的诊断存在差异性;DIC(+)患者28d病死率高于DIC(-)患者。肿瘤合并DIC患者与非肿瘤疾病合并DIC患者相比,血小板计数减少、白细胞计数增多显著、出血较严重,但后者存在更为明显的APTT延长。
Objective To investigate the differences and characteristics between clinical manifestations and laboratory indicators of malignant tumor complicating disseminated intravascular coagulation(DIC)and nonneoplastic diseases complicating DIC.Methods The patients with suspected malignant tumor complicating DIC and non-neoplastic diseases complicating DIC in the Yuxi Municipal People′s Hospital from January 2012 to December 2018 were diagnosed by using the diagnostic criteria of 2017 edition of the Chinese Diagnostic Integral System for disseminated intravascular coagulation(CDSS).The differences and characteristics in clinical manifestations and laboratory indicators were compared and analyzed.Results(1)Among 206 cases of suspected DIC,there were 49 cases of tumor complicating DIC,accounting for 69.01%,which was higher than 35 cases(25.93%)of non-neoplastic diseases complicating DIC,and the difference was statistically significant(P<0.001);the 28 dmortality rate in the patients diagnosed as DIC(+)was 79.76%,which was higher than 64.75%in the patients with DIC(-),and the difference was statistically significant(P<0.05).(2)The incidence rate of bleeding and severe bleeding(grade 2 bleeding):the bleeding incidence rate in non-neoplastic diseases complicating DIC was higher than that in tumor complicating DIC(P<0.05),the incidence rate of grade 2 bleeding was 57.14%,which was lower than 59.18%in tumor complicating DIC,but the difference was no statistically significant(P>0.05);in hemorrhage site,bleeding in skin,mucosal membrane petechiae,ecchymosis and digestive tract was more common in the tumor complicating DIC group;the bleeding in urinary tract and digestive tract was more common in the non-neoplastic diseases complicating DIC group.(3)The laboratory indicators:the proportion of platelets<50×10^9/L in the malignant tumor with DIC group was higher than that in the non-neoplastic diseases complicating DIC group(P<0.01);the white bloot cell count in the tumor complicating DIC group was higher than that in the non-neoplastic diseases complicating DIC group(P<0.05).The platelets count decrease in the tumor complicating DIC group was more significant than that in the non-neoplastic diseases complicating DIC group(P<0.05);the activated partial thrombin time(APTT)prolongation in the non-neoplastic diseases complicating DIC group was more significant than that in the tumor complicating DIC group(P<0.01).There was no statistically significant difference in prothrombin time(PT),fibrinogen(FIB)and D-dimer(D-D)levels between the two groups(P>0.05).Conclusion The 2017 version of CDSS can improve the diagnostic accuracy rate of DIC.There are the difference in the diagnosis of DIC existed in the two types of diseases.The 28 dmortality rate in the patients with DIC(+)is higher than that in the patients with DIC(-).The platelets decrease,white bloot cell significant increase and serious bleeding in the patients with tumor complicating DIC are more significant than those in the patients with non-neoplastic diseases complicating DIC,while more significant APTT prolongation exists in the latter.
作者
朱理平
王永志
潘宝龙
朱士红
孙竞
ZHU Liping;WANG Yongzhi;PAN Baolong;ZHU Shihong;SUN Jing(Department of Hematology;Department of Clinical Laboratory,Yuxi Municipal People′s Hospital,Yuxi,Yunnan 653100,China;Department of Hematology,Southern Hospital of Southern Medical University,Guangzhou,Guangdong 510515,China)
出处
《检验医学与临床》
CAS
2020年第4期476-480,486,共6页
Laboratory Medicine and Clinic
关键词
肿瘤
凝血功能
弥散性血管内凝血
tumor
coagulation function
disseminated intravascular coagulation
