按ISTH评分诊断的弥散性血管内凝血患者的临床特征分析

目的：探讨按ISTH评分诊断的弥散性血管内凝血（DIC）患者的临床表现、诊断、治疗及预后特征。方法：回顾性分析我院按ISTH评分诊断的928例DIC患者的临床资料,包括原发病、临床表现、止凝血指标、治疗及预后等。结果: 40.63%出现不同程度出血，38.04%出现休克，56.36%出现器官衰竭。感染占DIC原发病比例最高（44.40%），感染DIC器官衰竭发生率最高（62.62%）；病理产科DIC出血率最高（76.92%），休克率最高（73.08%），有效率最高（65.38%），死亡率最低(0.00%)；恶性肿瘤DIC死亡率最高（35.88%），与总计发生率相比差异显著（P<0.05）。有效组和无效组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及D-二聚体（DD）比较差异显著(P<0.05)，纤维蛋白原浓度(FIB)及血小板（PLT）最低值比较差异不显著(P>0.05)。PLT下降越率越高，DIC患者有效率越低，且差异显著（P<0.05）；国际血栓与止血协会（ISTH）显性积分越高，DIC患者有效率越低，且差异显著（P<0.05）。结论：出血是DIC典型的临床表现，器官衰竭更为常见；感染占DIC原发病比例最高，感染DIC器官衰竭发生率最高，病理产科DIC出血及休克发生率最高但预后最好，恶性肿瘤DIC预后最差；PT、APTT、DD、PLT下降率及ISTH显性积分有助于提示DIC患者的预后。

AnalysisStheSclinicalSfeaturesSofSpatientsSwithSdisseminatedSintravascularScoagulationSdiagnosedSbySISTHSscoring Yang Ting1,Gao Qing-ping*. Renmin Hospital of Wuhan University, Wuhan 430060 ,China

Objective: To investigate the clinical features, diagnosis , treatment and prognostic factors of disseminated intravascular coagulation diagnosed(DIC) by ISTH scoring. Method: Clinical data of 928 patients with DIC, including the underlying disease, clinical manifestations, hemostatic indicators , treatment and prognosis who diagnosed with DIC according to ISTH scoring in our hospital were analyzed retrospectively. Result: 40.63% had different degrees of hemorrhage, 38.04%had shock, 56.36%were combined organ failure. Infection accounted for the highest proportion of primary disease with DIC(44.40%), the highest organ failure rate (62.62%); pathology obstetrics group had the highest bleeding rate (76.92%), highest shock rate (73.08%) the highest efficiency(65.38%) , the lowest mortality rate (0.00%); the highest mortality rate (35.88%) of malignant tumors group, compared with the total incidence of the differences were statistically significant (P<0.05). Effective group and ineffective group of Prothrombin time (PT), activated partial thromboplastin time (APTT) and D- dimer (DD) were significantly different (P<0.05), fibrinogen concentration (FIB) and platelet (PLT) lowest value compared to the lack of statistically significant difference (P>0.05). PLT decreased more significantly, DIC patients with lower efficiency, and the difference was significant (P <0.05);with the higher ISTH dominant scoring, DIC patients with lower efficiency, and the difference was significant (P <0.05).Conclusion: Bleeding is the most typical clinical manifestations of DIC, but organ failure is more common.;infection accounted for the highest proportion of primary disease with DIC and the highest incidence of organ failure, pathological obstetrics with DIC prognosis is best and the highest incidence of hemorrhage and shock, worst prognosis of malignant tumor with DIC. PT, APTT, DD , PLT decline rate and ISTH dominant scoring contribute to forecast the prognosis of DIC patients.