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題 名 | Can Advanced Hemostatic Parameters Detect Disseminated Intravascular Coagulation More Accurately in Patients with Cirrhosis of the Liver?=以更先進之凝血參數測定肝硬化病人之瀰散性血管內凝血是否更準確 |
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作 者 | 何照洪; 侯明志; 林漢傑; 李壽東; 劉顯敏; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:6 1998.06[民87.06] |
頁 次 | 頁332-338 |
分類號 | 415.534 |
關鍵詞 | 瀰散性血管內凝血; 纖維蛋白分解活性; 凝血參數; 肝硬化; Disseminated intravascular coagulation; Fibrinolytic activity; Hemostatic parameters; Liver cirrhosis; |
語 文 | 英文(English) |
中文摘要 | 背景;由於瀰散性血管內凝血(DIC)呈複雜之凝血改變,使肝硬化病人DIC之實驗診斷顯 得困難。在最近,偵測新的分子凝血標記也許可以改善DIC之診斷。本研究是評估更先進之凝 血試驗對肝硬化病人發生DIC之診斷是否有幫助。 方法:為了評估肝硬化病人之DIC發生率,我們在51位肝硬化病人中進行活化部分血栓 質時間(APTT)、凝血酵元時間(PT)、凝血酵素時間(TT)、第八因子定量、抗凝血酵(AT)活性、 纖維蛋白原、胞漿素原、魚精蛋白硫酸鹽試驗(PST)、纖維蛋白分解物(FDP),D-dimer、凝血酵 素-抗凝血酵素III複合物(TAT)(利用修正抗凝血酵素測定,ATM)、優球蛋白凝固溶解時間(ELT) 和血小板計數。DIC之診斷包括以下標準:(a)血小板<80x10±/l; (b)PT>1.5; (c)APTT>1.3; (d)TT>24秒; (e)AT<60%; (f)ATM>14.7 ng/m1(normal mean±3SD);(g)纖維蛋白原<1.50 g/l; (h)PST陽性; (i)D-dimer>1.0 g/ml); (i)FDP>20 mg/ml; (k)ELT<150 min; (l)胞漿素原<50%。 DIC之認定必須存在6個以上之項目,其中至少有兩項來自(a)到(h),表示凝血的改變,及至少有 兩項來自(g)到(i),表示纖維蛋白分解的改變。 結果:利用更先進之凝血試驗,有8位病人符合DIC之診斷標準,但若用一般方法之凝血 試驗則只有其中2位符合標準,而這8位病人之第八因子濃度並沒有明顯降低。 結論:更先進之凝血試驗測定DIC有高敏感度的結果,但這只是因為有更多機會、更多 的試驗所獲得之結果,而不是由新的試驗本身所提供的。 |
英文摘要 | Background: Laboratory diagnosis of disseminated intravascular coagulation (DIC) is difficult in patients with cirrhosis of the liver due to the complicated hemostatic changes of DIC. More recently, newer molecular hemostatic markers have been used to improve the diagnosis of DIC. This study evaluated the ability of the more advanced hemostatic tests to diagnose DIC in patients with cirrhosis of the liver. Methods: A series of hemostatic tests and parameters including activated partial throm- boplastin time (APTT), prothrombin time (PT), thrombin time (TT), factor VIII assay, antithrombin (AT) activity, fibrinogen, plasminogen, protamine sulfate test (PST), fibrin(ogen) degradation product (FDP), D-dimer, thrombin-antithrombin complex (TAT) (measured by modified antithrombin, ATM), euglobulin lysis test (ELT) and platelet count were performed in 51 patients with cirrhosis of the liver. A diagnosis of DIC was made according to the following parameters and criteria: a) platelets less than 80 x l0±/l; b) PT greater than 1.5, c) APTT greater than 1.3; d) TT greater b) than 24 sec; e) AT less than 60%; f) ATM greater than 14.7 ng/ml (normal, mean ± 3 SD); g) c) fibrinogen less than 1.50 g/l; ±hi positive PST, i) D-dimer greater than 1.0 ±g/ml; j) FDP d) greater than 20 ±g/m1; k) ELT less than 150 mm; 1) plasminogen less than 50%. DIC was diagnosed if six or more of the above items were present, and at least two of them were item (a) to (h), and at least two were item (g) to(l). Results: Although eight patients had results that fitted the diagnostic criteria of DIC by using the more advanced tests, only two of them were diagnosed with DIC by conventional testing. The concentration of factor VIII in these eight patients did not markedly decrease. Conclusions: New tests are not necessary to improve the diagnosis of DIC in patients with cirrhosis of the liver. |
本系統中英文摘要資訊取自各篇刊載內容。