弥散性血管内凝血诊断评分标准在产科的应用评价

目的 采用已有的4种国际非孕弥散性血管内凝血（DIC）诊断评分标准对产科DIC的诊断进行评估，探索更适合产科DIC诊断的“金标准”。 方法 选择2009年6月－2012年6月期间产科拟诊DIC的孕产妇为研究对象，用日本卫生福利部（JMHW）提出的JMHW、日本危重病协会（JAAM）提出的JAAM、国际血栓与止血委员会（ISTH）提出的ISTH显性和ISTH非显性4种诊断评分标准联合诊断和构建“金标准”，以此评价4种诊断标准对产科DIC诊断的特性。 结果 受试者工作特征（ROC）曲线分析显示ISTH非显性标准、ISTH显性标准、JMHW、JAAM的ROC曲线下面积分别为0.939、0.865、0.867、0.867，ISTH非显性标准灵敏度和特异度与“金标准”在不同诊断界值时较一致，同时优于其他3种诊断标准。 结论 ISTH非显性标准较适合作为临床产科DIC诊断，其对产科这一特殊发病人群的DIC诊断具有更科学的临床诊断价值。

Evaluation of Diagnostic Criteria for Disseminated Intravascular Coagulation in Obstetric Patients

Objective To evaluate obstetric Disseminated Intravascular Coagulation （DIC） with four current DIC diagnostic criteria and explore a more rational ＂golden standard＂, as DIC is a severe complication in obstetric disease with its pathogenetic mechanism different from non-pregnant DIC patients, but without available sensitive and specific diagnostic standard. Methods We studied the obstetric patients who had been suspected with DIC between June 2009 and June 2012. We diagnosed the patients selected by the ＂golden criteria＂ we devised and the four current criteria： Japan Ministry of Health and Welfare （JMHW）, Japanese Association of Acute Medicine （JAAM）, the International Society Thrombosis ＆ Hemostasis （ISTH） recommended ISTH overt and ISTH non-overt criterion respectively. Then, we compared the four criteria with the ＂golden criteria＂ and assessed the feasibility of the current criteria. Results The receiver operating characteristic （ROC） analysis indicated that the area under the curve （AUC） was 0.939 by ISTH non-overt criterion calculation, which was 0.865 by ISTH overt criterion calculation, 0.867 by JMHW criterion calculation and 0.867 by JAAM criterion calculation respectively. The sensibility and specificity of ISTH non-overt criterion were consistent with the ＂golden standard＂ at different cutoff value and were better than the other three diagnostic criteria. Conclusions The ISTH non-overt criterion is more rational and suitable for clinical diagnosis of obstetric DIC. It has more scientific value of DIC clinical diagnosis for obstetric population.