Pathogenesis and diagnosis of disseminated intravascular coagulation
Pathogenesis and diagnosis of disseminated intravascular coagulation
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DOI：
10.1111/ijlh.12830
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发表时间：
2018-05-01
影响因子：
3
通讯作者：
Levi, M.
中科院分区：
文献类型：
--
作者：
Levi, M.
几种临床病症，特别是与全身炎症反应相关的那些，可引起某种程度的凝血激活，但当促凝血刺激足够严重并克服凝血的天然抗凝机制时，可能发生弥散性血管内凝血（DIC）。DIC的临床表现包括微循环中纤维蛋白-血小板凝块引起的多器官功能障碍，以及血小板和凝血因子消耗引起的出血。在炎症诱导的凝血效应中发挥作用的分子机制已被详细认识。血液暴露于组织因子是最常见的触发因素，而血管内凝血是由于生理抗凝剂功能丧失和纤维蛋白溶解受损而传播的。在DIC患者中，可能会观察到常规凝血参数的各种异常，包括血小板减少、整体凝血试验延长或纤维蛋白分裂产物水平升高。此外，更复杂的测试激活的个别因素或途径的凝血可能指向特定参与这些成分的发病机制的障碍。一个现成的测试的组合通常是足够的，在建立DIC的诊断，并为此目的，已经开发了几个评分算法。一些特定的临床情况可能引起凝血反应，这些反应可以与DIC区分开来，也可能与DIC合并发生，包括稀释性凝血病、肝功能衰竭相关的凝血紊乱和血栓性微血管病。
Several clinical conditions, in particular those associated with a systemic inflammatory response, can cause some degree of activation of coagulation but when the procoagulant stimulus is sufficiently severe and overcomes the natural anticoagulant mechanisms of coagulation, disseminated intravascular coagulation (DIC) may occur. The clinical manifestations of DIC encompass multiorgan dysfunction caused by fibrin-platelet clots in the microcirculation, and bleeding caused by consumption of platelets and coagulation factors. Molecular mechanisms that play a role in inflammation-induced effects on coagulation have been recognized in much detail. Exposure of blood to tissue factor is the most common trigger, whereas the intravascular coagulation is propagated due to loss of function of physiological anticoagulants and impaired fibrinolysis. In patients with DIC, various abnormalities in routine coagulation parameters may be observed, including thrombocytopenia, prolonged global coagulation assays, or high levels of fibrin split products. In addition, more sophisticated tests for activation of individual factors or pathways of coagulation may point to specific involvement of these components in the pathogenesis of the disorder. A combination of readily available tests is usually sufficient in establishing the diagnosis of DIC, and for this purpose, several scoring algorithms have been developed. Some specific clinical situations may elicit coagulation responses that can be distinguished from DIC or may occur in combination with DIC, including dilutional coagulopathy, liver failure-related coagulation derangement, and thrombotic microangiopathies.