感染性休克患者D-二聚体水平的变化与弥散性血管内凝血的关系

目的 研究感染性休克患者D-二聚体水平的变化与弥散性血管内凝血（DIC）的关系.方法 将188例感染性休克患者按是否发生DIC分为DIC组（36例）和非DIC组（152例）,患者血清D-二聚体水平采用全自动乳胶微粒增强定量免疫比浊法进行测定,采用受试者工作特征（ROC）曲线计算血清D-二聚体水平的截断值.结果 DIC组和非DIC组休克后1d血清D-二聚体水平比较差异无统计学意义[（1258.69±296.34） mg/L比（1108.45±226.23） mg/L,P＞0.05];DIC组休克后3、5、7d血清D-二聚体水平显著高于非DIC组[（1468.95±448.78） mg/L比（967.76±214.32） mg/L、（1702.12±578.40） mg/L比（886.57±187.22） mg/L、（1924.21±796.76） mg/L比（821.46±178.32） mg/L],差异有统计学意义（P＜0.05）.采用ROC曲线计算血清D-二聚体水平的截断值为303 mg/L,以血清D-二聚体水平≥1203μg/L来判断感染性休克后发生DIC的敏感度为81.5％,特异度为76.3％.结论 感染性休克患者血清D-二聚体水平的变化不仅与患者的疾病严重程度相关,还与患者是否发生DIC有密切的关系.因此测定患者血清D-二聚体水平对感染性休克患者的诊断和判断预后有重要的临床意义.

Relationship between D-dimer levels and disseminated intravascular coagulation in septic shock patients

Objective To study the relationship between D-dimer levels and disseminated intravascular coagulation（DIC） in septic shock patients.Methods A total of 188 patients with septic shock were divided into DIC group （36 cases） and non-DIC group（152 cases）.Serum D-dimer of the patients was detected by automatic latex particle enhanced immunoturhidimetric assay,serum D-dimer cutoff value was calculated by receiver operating characteristics （ROC） curve.Results There was no significant difference in serum D-dimer after 1 d shock between DIC group and non-DIC gorup [（1258.69 ± 296.34） mg/L vs.（1108.45 ± 226.23） mg/L,P ＞ 0.05].Serum D-dimer after 3,5,7 d shock in DIC group was higher than that in non-DIC group [（1468.95 ±448.78） mg/L vs.（967.76 ±214.32） mg/L,（1702.12 ±578.40） mg/L vs.（886.57 ± 187.22） mg/L,（1924.21 ±796.76） mg/L vs.（821.46 ± 178.32） mg/L],there was significant difference （P ＜0.05）.Serum D-dimer cutoff value was 303 mg/L,calculating by ROC curve,and on condition of serum D-dimer ≥1203 μg/L,the sensitivity that judged the DIC occurrence rate after septic shock was 81.5％ and specificity was 76.3％.Conclusions Serum D-dimer changes of the patients with septic shock not only relate to the patient＇s disease severity,but also have a close relationship to whether DIC happen.Therefore,determination of serum levels of D-dimer in patients with septic shock has important clinical significance to the diagnosis and prognosis.