| Objective:The purpose of this research was to investigate the clinical value of plasma thrombin antithrombin complex(TAT),plasminase-antiplasmin complex(PIC),thrombomodulin(TM),tissue plasminogen activation inhibitory complex(t-PAIC)levels in the early diagnosis and prognosis of disseminated intravascularcoagulation(DIC).Methods:Sixty-four patients with high suspicion of DIC who were admitted to the The First Affiliated Hospital of Gannan Medical College from November 1,2021 to November 1,2022,were enrolled.All patients met the inclusion criteria of this study.All samples were collected withthe consent ofthe patients or theirfamilies,and signed the relevant informed consent form,and the experiment was approved by the Ethics Committee of the First Affiliated Hospital of Gannan Medical College.According to the 2017 edition of Chinese expert consensus on the diagnosis of disseminated intravascular coagulation(CDSS)(Table 1),DIC was diagnosed and grouped: DIC group(31 cases): 1 day before reaching the diagnosis was defined as pre-DIC period,when reaching the diagnostic criteria was defined as overt DIC period;non-DIC group(33 cases): divided into non-DIC group(day 1)and non-DIC group(day 2).According to whether they survived within 7 days of enrollment,DIC group was divided into survival group and death group.Healthy control group: 50 healthy subjects aged 21-72 who underwent physical examination in the the The First Affiliated Hospital of Gannan Medical College during the same period were collected.Plasma TAT,PIC,TM and t-PAIC levels were detected by magnetic particle chemiluminescence immunoassay.SPSS25.0 software was used for analysis of data entry and statistics.Percentage(%)was used for classification data,and mean ±standard deviation((?)±S)was used for measurement data of normal distribution,and two independent sample t tests were used for comparison between groups.The measurement data with non-normal distribution was represented by M(P25-P75),and the Mann-Whitney U test was used for comparison between groups.The Chi-square test was used for comparison between count data groups.Plasma TAT,PIC,TM,t-PAIC,platelet(PLT),fibrinogen(FIB),prothrombin(PT),active partial thromboplastin time(APTT)and D-Dimer(D-D)levels were compared between groups,and receiver operating characteristic(ROC curve)was drawn,the diagnostic cut-off point and diagnostic efficiency were determined,the area under the ROC curve(AUC value),cut-off value,sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)were calculated,and the differences of TAT,PIC,TM and t-PAIC separately or in combination were compared,and the four indexes of thrombosis were compared with the routine coagulation indexes.To evaluate the clinical value of four molecular markers TAT,PIC,TM andt-PAIC inthe early diagnosis andprognosis of DIC.Results:There was no significant difference in age and gender among the groups.Comparison of various indicators in different groups: in the DIC group(pre-DIC period),plasma TAT[102.08(24.09-120.00)ng/m L],PIC[6.82(1.59-19.86)μg/m L],TM[20.66(12.09-27.01)TU/m L],t-PAIC[19.68(12.75-29.73)ng/m L] were significantly higher than those of non-DIC group(day 1)and healthy control group(P<0.05),and the difference between non-DIC group(day 1)and healthy control group was statistically significant(P<0.05).The plasma TAT[71.51(30.98-120.00)ng/m L],PIC [5.79(2.07-15.16)μg/m L] and t-PAIC[19.68(13.27-36.33)ng/m L]levels in DIC group(overt DIC period)were significantly higher than those in non-DIC group(day 2)(P<0.05).There was no significant difference in TM between the above two groups(P>0.05).In DIC group(overt DIC period)and non-DIC group(day 2),the four indexes of thrombosis weresignificantly higher than thosein healthy control group(P<0.05).Routine coagulation indicators: platelet(PLT),fibrinogen(FIB),prothrombin(PT),active partial thromboplastin time(APTT),and D-Dimer(D-D)in DIC group,non-DIC group and healthy control group were compared between each two groups,and the differences were statistically significant on the first day and the second day(P<0.05).There was no significant difference in the four indexes of thrombosis and routine coagulation indexes PLT,FIB and PT between the DIC group(pre-DIC period)and the DIC group(overt DIC period)at different times(P>0.05),but there was significant difference in APTTand D-dimer(P<0.05).There was no significant difference in the four indexes of thrombosis and routine coagulation indexes betweenthe non-DIC group(day 1)and the non-DIC group(day 2)(P>0.05).The diagnostic value of TAT,PIC,TM and t-PAIC was analyzed by ROC curve and AUC value.The cut-off value of the test index was determined by the maximum Youden index,and the sensitivity,specificity,PPVand NPVwere calculated.When evaluating the diagnostic value of the four indexes in DIC group(pre-DIC period)and non-DIC group(day 1),DIC group(overt DIC period)and non-DIC group(day 2),plasma TAT,PIC,TM and t-PAIC levels were tested separately,and the largest area under the ROC curve(AUC)of DIC was TAT,which was0.838 and 0.826,respectively.The lowest AUC in DIC group(pre-DIC period)and non-DIC group(day 1)was t-PAIC(0.687).The lowest AUC in DIC group(overt DIC period)and non-DIC group(day 2)was TM(0.621).When TAT and PIC are combined,the AUC values were 0.855 and 0.839,the sensitivities of which were 83.9% and 71.0%,the specificitices of which were 78.8% and 84.8%,the positive predictive values of which were 78.8% and 81.5%,and the negative predictive values of which were 83.9% and 75.5%,respectively.When the four markers were combined,the AUC values were 0.926 and 0.873,the sensitivities which were 87.1% and 71.0%,the specificities which were 87.9% and 93.9%,the positive predictive values which were 87.1% and 91.7%,and the negative predictive values which were 87.9%and 77.5%,respectively.The results of the two groups showed that the combined detection of plasma TAT,PIC,TM and t-PAIC had better diagnostic efficacy than the single detection of eachindex.The AUC of combined detection of PT,APTT and D-dimer was 0.896 and 0.948,the sensitivity of which was 64.5% and 93.5%,the specificity of which was 97.0% and 84.8%,the positive predictive value of which was 95.2% and 85.3%,and the negative predictive value of which was 74.4% and 93.3%,respectively.When combined detection,the diagnostic efficacy of the four indicators of thrombosis is better than that of the combined detection of routine coagulation indicators on the first day,and the diagnostic efficacy of routine coagulation indicators is better than that of the combined detection of four indicators of thrombosis on the second day.Based on the above data,we found that the diagnostic value of DIC was different in different periodsof DIC group.The AUC values of TAT,PIC,TM and t-PAIC in the DICgroup(pre-DIC period)were larger than those in the DIC group(overt DIC period),and the diagnostic value was higher,especially when combined diagnosis was made.The AUC of the DIC group(pre-DIC period)was 0.926,the sensitivity and specificity were 87.1% and 87.9%,respectively,and the negative predictive value and positive predictive value were 87.9% and87.1%,respectively.It was significantly higher than that in DIC group(overt DIC period).In addition,the plasma TAT,PIC,TM and t-PAIC levels of the death group and the survival group on the day of grouping were compared.The plasma TAT level of the death group was significantly higher than that of the survival group(P<0.05),while there were no significant differences in plasma PIC,TM and t-PAIC levels(P>0.05).Conclusion:1.The combined detection of plasma TAT,PIC,TM and t-PAIC levels has certain clinical guiding significance for theearly diagnosis of DIC.2.The significant increaseof TAThas a certain auxiliary valuein theprognosis of DIC. |
PDF Full Text Request