DIC弥漫性血管内凝血北京协和医院血液科课件.pptVIP

DIC的诊断与治疗北京协和医院血液科

DIC的定义DisseminatedIntravascularCoagulationDIC是一种发生于多种疾病或特殊病理状态下，人体凝血系统被激活而引起中小血管内弥漫性微血栓形成及继发性纤溶亢进的综合征。由于DIC发展过程中出现不同程度的血小板和凝血因子水平消耗性减少，也称之为“消耗性凝血病”或“消耗性血栓出血性疾病”。

ClinicalconditionsassociatedwithDIC1.Sepsis/Severeinfection--- -------- 44.6%2.Malignancy------------------------- 20.7%Solidtumors6.9%，AL13.8%.OccurrenceinAPL37~65%.3.Obstetricalcalamities------------ 13.4%Amnioticfluidembolism,Abruptioplacentae,Deadfetus4.Trauma/Surgery----------------- 7.4%5.Severehepaticfailure------------ 7.4%6.VascularabnormalitiesKasabach-Merrittsyndrome，Largevascularaneurysms7.Organdestruction(e.g.,severepancreatitis)8.SeveretoxicorimmunologicreactionsSnakebites，Recreationaldrugs，Transfusionreactions，Transplantrejection

MortalityDIC----DeathIsComing.Mortalityrangesfrom31~86%,whetherornotheparinwasadministrated.CorrelatedFactors:UnderlyingdisordersTheextentoforgondysfuctionThedegreeofhemostaticfailureIncreasingage

TheSimplifiedMechanismofDIC

DIC的失调控Sepsis、Cancer、Trauma、Obstetricalcomplications:TF?LiverDisease:AT-III、PC/PS?Sepsis:TM、PC?Pregnancy:PS?APL、AmnioticFluidEmbolism、ProstateCancer:Plasmin?

ThrombinExplosionunderPathologicalConditions

IXa(+VIII)Xa(+V)TF+VIIaThrombinFibrinogenFibrinDecreaseofAT-IIIImpairmentofPCSystemInsufficientTFPICytokines(IL-6,etc.)PlasminogenPlasminFibrinFDPsPAPAI-1GenerationofThrombinMediatedbyTFImpairmentofAnticoagulationPathwaySuppressionofFibrinolysisbyPAI-1FormationofFibrinInadequateRemovalofFibrinThrombosisofSmallandMidsizeVesselsPathogeneticPathwaysInvolvedinDIC

AbnormalCoagulationinDIC

PhysiologicAnticoagulantPathways

DysfunctionofthePCSysteminDIC

SchistocytesIntravascularFibrin

DIC临床表现频率临床表现各异，根据6组报道平均发生率(WilliamsHematology-6thEdition，Table126-2)1.出血表现： 77.3%2.肾损害： 46.4%3.呼吸道表现：42.2%4.肝损害： 39.5%5.休克： 34.5%6.CNS表现： 22.8%7.血栓栓塞： 22.2%8.肢端苍白： 6.8%9.其它

DIC的实验室检查MarkersofThrombinGen