最新 弥散性血管内凝血.pptVIP

弥散性血管内凝血Disseminated intravascular coagulation 定义 2001年国际血栓与止血学会DIC专题委员会新的定义：“DIC是一种由不同原因引起的，以全身性血管内凝血系统激活为特征的获得性综合征。这种改变可来自并引起微血管系统的损害，严重时可导致器官功能衰竭”。 Disseminated intravascular coagulation is not a disease or a symptom but a syndrome, which is always secondary to an underlying disorder. The syndrome is characterized by a systemic activation of the blood coagulation system, which results in the generation and deposition of fibrin, leading to microvascular thrombi in various organs and contributing to the development of multi-organ failure. Consumption and subsequent exhaustion of coagulation proteins and platelets, because of the ongoing activation of the coagulation system, may induce severe bleeding complications, although microclot formation may occur in the absence of severe clotting factor depletion and bleeding (Levi et al, 1999). 很多疾病都可引起DIC，感染性疾病占36.94%，病理产科24.81%，恶性肿瘤24.2%，手术与创伤4.34%。 Table Clinical conditions that may be associated with disseminated intravascular coagulation Table Clinical conditions that may be associated with disseminated intravascular coagulation Pathogenesis In recent years, the mechanisms involved in pathological microvascular fibrin deposition in DIC have become increasingly clear. Initiation of coagulation is tissue factor-dependent; amplification of thrombin generation is caused by defective physiological anticoagulant mechanisms; and propagation of fibrin deposition in the microvasculature is caused by insufficeient fibrin degradation, as a result of an inhibited fibrnolytic system (Fig). Pathogenesis Traditionally, DIC was thought to be the result of both the extrinsic and the intrinsic (contact system-mediated) coagulation pathways being activated. In the last 20 years it has become apparent that thrombin generation in DIC is exclusively mediated by the extrinsic (factor VIIa) pathway. Tissue factor may be expressed on activated and inactivated mononuclear cells and endothelial cells, and is capable of binding factor VIIa,