42例弥散性血管内凝血临床病例分析.docVIP

42例弥散性血管内凝血临床病例分析 　　【摘 要】目的：对42例弥散性血管内凝血（disseminated intravascular coagulation，DIC）的临床病例进行分析，提高临床医师对DIC严重程度的重视，并寻找早期诊断DIC的实验室指标。方法：入组DIC临床病例42例，分析其基础疾病、实验室检查的特点，比较肝病组和其它病因组在出血症状及器官损害等方面的区别。结果：42例DIC患者的基础疾病以严重肝病（71.4%）和严重感染（14.3%）多见。与非肝病组比较，肝病组DIC出血症状较轻，但器官损害较重。42例DIC患者100%发生D-二聚体升高，治疗有效的DIC患者D-二聚体均不同程度下降。结论：DIC可由多种原发性疾病引起。肝病组DIC器官损害较重，但严重感染等非肝病组DIC出血症状较重。D-二聚体可作为DIC诊断及判断疗效的重要指标。 　　【关键词】弥散性血管内凝血；肝病；D-二聚体 　　[Abstract]Objective：To analyze 42 cases of disseminated intravascular coagulation（DIC）and improve the clinician’s attention to the severity of DIC and seek the laboratory markers of early diagnosis of DIC.Methods：Forty two patients with DIC were enrolled and their underlying diseases and laboratory tests were analyzed.The differences of bleeding and organ damage in liver disease group and non-liver disease group were monitored.Results：The major cause of DIC in the 42 cases was severe liver disease（71.4%），the second common cause was serious infections（14.3%）.Compared to non-liver disease，bleeding was mild in liver disease group but organ damage was more serious.The level of D-dimer was elevated in 100% of the 42 cases and its level was decreased to varying degrees in those patients with DIC after treatment.Conclusion：DIC is caused by a variety of primary diseases.In severe liver disease group，the organ damage was serious；nevertheless，bleeding was mild compared to non-liver disease group.D-dimer might be considered as an important indicator to diagnose and judge the efficacy of DIC. 　　[Keywords]DIC；Liver disease；D-dimer 　　弥散性血管内凝血是一种由多种基础疾病引起的临床综合征。由于血液内凝血机制被弥散性激活，促发小血管内广泛纤维蛋白沉着，导致组织和器官损伤，另一方面，由于凝血因子被消耗可引起全身性出血倾向。因此临床上DIC以出血和血栓并存，同时可伴有多器官功能衰竭[1，2]。DIC的病因来自于基础疾病，如肝病、严重感染、急性早幼粒细胞性白血病等[3]。本文收集了我院42例DIC患者的临床资料，通过回顾性分析其基础疾病、DIC临床表现及实验室检测指标的特点，并对疾病预警指标进行了初步评价。 　　1、资料与方法 　　1.1研究对象 　　选择2007年01月～2015年6月间在我院治疗的DIC患者42例，按照《DIC诊断标准》确诊[5]。其中，男性患者24例，女性患者18例；年龄19～67岁，中位年龄35.5岁。主要原发病为严重肝病30例，占71.4%；其它基础疾病12例，包括严重感染6例（14.3%）、急性早幼粒细胞性白血病3例（7.1%）、羊水栓塞2例（4.8%）及实体肿瘤1例（2.4%）。均符