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目的 观察儿童止凝血分子标志物的变化以探索其在前DIC(Pre -DIC)诊断中的意义。方法 分为正常对照组、DIC组和Pre -DIC组 ,用发色底物法测定血浆抗凝血酶III(AT -III) ,用ELISA法检测血浆凝血酶 -抗凝血酶III复合物 (TAT)、组织因子(TF)、组织因子途径抑制物 (TFPI)。结果 DIC组 (n =17)患儿TAT、TF含量显著升高 ,AT -III含量显著降低、TFPI含量稍降低 ,与正常对照组 (n =18)比较 ,TF、AT -III差异有显著性 (P <0 0 1)。TAT有显著性差异 (P <0 0 5 ) ,而TFPI差异无显著性 (P >0 0 5 )。DIC前状态组 (n =2 8)患儿TAT、TF含量显著升高、AT -III含量显著降低 ,与正常对照组比较 ,差异显著 (P <0 0 1) ,TFPI差异无显著性。AT -III、TAT、TF对Pre -DIC诊断的灵敏度分别为 85 7%、89 3 %、96 4% ,特异性为 64 7%、76 5 %、82 4% ;联合应用 3项指标其灵敏度为 82 1% ,特异性为 88 2 %。结论 凝血分子标志物AT -III、TAT、TF能早期反体内凝血及抗凝血系统的活性 ,对Pre -DIC的诊断有重要意义。多项分子标志物的联合应用可提高Pre -DIC的确诊率。TF对DIC的发展和进程具有预示作用。
Objective To observe the changes of coagulation markers in children to explore its significance in the diagnosis of pre-DIC. Methods The normal control group, DIC group and Pre-DIC group were divided into three groups: the plasma anti-thrombin III (AT-III) by chromogenic substrate method, the plasma thrombin-antithrombin III complex TAT), tissue factor (TF), tissue factor pathway inhibitor (TFPI). Results The levels of TAT and TF in DIC group (n = 17) were significantly higher than those in control group (n = 17), while the contents of AT-III and TFPI decreased slightly (P <0 0 1). TAT was significantly different (P <0 05), while TFPI was no significant difference (P 0 05). In the pre-DIC group (n = 28), the levels of TAT and TF were significantly increased and the content of AT-III was significantly lower in children than in the normal control group (P <0.01). There was no significant difference in TFPI between the two groups. The sensitivities of AT-III, TAT and TF to the diagnosis of Pre-DI were 85.7%, 89.3% and 96.4%, respectively, with specificity of 64.7%, 76.5% and 82.4% 82 1% and specificity 88 2%. Conclusion The coagulation molecular markers AT-III, TAT and TF can inhibit the activity of blood coagulation and anticoagulant system in early stage, which is of great significance for the diagnosis of Pre-DI. The combination of multiple molecular markers can improve the diagnosis of Pre-DIIC. TF has a predictor of the development and progression of DIC.