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目的:评价弥散性血管内凝血(DIC)4个积分系统:JMHW评分、ISTH显性评分、JAAM评分和MJAAM评分在DIC诊断与预后评估中的作用;并分析各凝血指标对DIC的诊断价值及预后的影响。方法:搜集疑诊为DIC的非恶性血液病患者共579例,并对搜集患者的临床资料进行回顾性分析。分别根据4个积分系统进行评分并比较各评分标准对非恶性血液病DIC的诊断效能及死亡预判效果;分析各凝血指标对DIC的诊断价值及预后的影响。结果:M-JAAM评分对DIC的诊断阳性率最高(74.96%),与JAAM评分的诊断符合率为97.75%,32例(16.67%)先于ISTH评分被诊断为DIC,16例(6.45%)先于JMHW评分被诊断为DIC,MJAAM评分对28d死亡预判效果最差(AUC=0.690),与AT活性的取值较高有关。JMHW评分对DIC的死亡预判最佳(AUC=0.775),但JMHW评分诊断率(42.83%)不如JAAM评分(74.09%)和M-JAAM评分(74.96%)。ISTH评分相对于其他标准,诊断阳性率(33.16%)及死亡预判(AUC=0.721)均没有优势。JAAM评分诊断阳性率略低于M-JAAM评分,但死亡预判效果(AUC=0.705)高于M-JAAM评分(AUC=0.690)。临床表现的发生率、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、抗凝血酶(AT)、D-二聚体(D-D)和纤维蛋白(原)降解产物(FDP)在DIC阳性组和DIC阴性组间均差异有统计学意义(P<0.05)。PLT、PT、APTT、D-D、FDP、AT与DIC的预后及积分值相关性较好。结论:为了早期发现DIC,JAAM评分和M-JAAM评分更有利,如已达到JMHW评分诊断为DIC时,则患者死亡风险高,应予以高度重视;PLT、PT、APTT、AT、D-D、FDP、AT对DIC的诊断及预后评估均有一定价值。
PURPOSE: To evaluate the effect of DIC on the four integral systems of diffuse intravascular coagulation (DIC): JMHW score, ISTH dominant score, JAAM score and MJAAM score in diagnosis and prognosis of DIC. The impact of prognosis. Methods: A total of 579 cases of suspected non-hematologic malignancies suspected of DIC were collected, and the clinical data of patients collected were retrospectively analyzed. According to the four integral systems, the scores of each score were compared and the diagnostic efficacy and the predictive value of death for each non-hematologic disease were compared. The diagnostic value and prognosis of DIC were analyzed. Results: The positive rate of M-JAAM in diagnosing DIC was the highest (74.96%), the coincidence rate with JAAM was 97.75%, 32 (16.67%) were diagnosed as DIC before ISTH, 16 cases (6.45% Prior to JMHW score was diagnosed as DIC, MJAAM score on 28d death predict the worst (AUC = 0.690), and the higher value of AT activity. JMHW score was the best predictor of DIC mortality (AUC = 0.775), but the diagnostic rate of JMHW score was 42.83% lower than that of JAAM score (74.09%) and M-JAAM score (74.96%). Compared with other criteria, the ISTH score had no diagnostic advantage (33.16%) and predictive mortality (AUC = 0.721). The positive rate of JAAM score was slightly lower than M-JAAM score, but the predictive value of death (AUC = 0.705) was higher than M-JAAM score (AUC = 0.690). The incidence of clinical manifestations, platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), antithrombin (AT), D-dimer (DD) and fibrin Original) degradation product (FDP) showed no significant difference between DIC-positive group and DIC-negative group (P <0.05). PLT, PT, APTT, D-D, FDP, AT and DIC prognosis and integral value is good. Conclusion: In order to detect DIC early, JAAM score and M-JAAM score are more favorable. If the JMHW score has been reached and DIC has been diagnosed, the risk of death is high and should be taken seriously. PLT, PT, APTT, AT, DD, FDP, AT diagnosis of DIC and prognosis have some value.