Usefulness of the APTT waveform for the diagnosis of DIC and prediction of the outcome or bleeding risk
Usefulness of the APTT waveform for the diagnosis of DIC and prediction of the outcome or bleeding risk
复制标题
DOI：
10.1186/s12959-019-0201-0
复制
发表时间：
2019-06-28
影响因子：
3.1
通讯作者：
Katayama, Naoyuki
中科院分区：
文献类型：
--
作者：
Suzuki, Kei;Wada, Hideo;Katayama, Naoyuki
背景资料：活化部分凝血活酶时间（APTT）波形的有用性已被报道在血友病，获得性血友病和抗凝剂监测。材料和方法：APTT波形检查在怀疑有弥漫性血管内凝血（DIC）的患者，以分析其有用性DIC的诊断或预测的结果或出血风险。纤维蛋白原<2g/L的DIC多与感染性疾病有关（43.3%）。一阶导数峰（1stDP）和二阶导数峰（2ndDP）的高度在弥散性血管内凝血（DIC）中极低，尤其是伴有低纤维蛋白原血症的弥散性血管内凝血（DIC），而在不伴有弥散性血管内凝血（DIC）的感染性患者中较高。DIC患者第1、2次DP峰值时间延长，峰宽延长。第1（st）DP和第2（nd）DP的高度在预后差或血红蛋白< 8.0 g/dl的患者中明显降低。讨论和结论：由于在感染性DIC中观察到出血型DIC，无低纤维蛋白原血症的DIC可能通过DIC的进展而转变为低纤维蛋白原血症的DIC。第1、第2 DP的高度对DIC的诊断和预测出血风险及预后有一定的价值。
Background: The usefulness of the activated partial thromboplastin time (APTT) waveform has been reported in hemophilia, acquired hemophilia and monitoring for anticoagulants.Material and methods: The APTT waveform was examined in patients suspected of having disseminated intravascular coagulation (DIC) to analyze its usefulness for the diagnosis of DIC or the prediction of the outcome or bleeding risk.Results: DIC with fibrinogen < 2 g/L was frequently associated with infectious diseases (43.3%). The heights of the first derivative peak (1stDP) and second DP (2ndDP) were extremely low in DIC, especially DIC with hypofibrinogenemia, but high in infectious patients without DIC. The peak time and width of the 1stDP and 2ndDP were prolonged in patients with DIC. The heights of the 1(st)DP and 2(nd)DP were markedly low in patients with a poor outcome or those with hemoglobin < 8.0 g/dl.Discussion and conclusion: As bleeding type DIC was observed in infectious DIC, DIC without hypofibrinogenemia might switch to DIC with hypofibrinogenemia by the progression of DIC. The height of the 1(st)DP and 2(nd)DP is useful for the diagnosis of DIC and prediction of the bleeding risk or outcome.