2017年版中国DIC诊断积分系统在急性早幼粒细胞白血病中的应用

OBJECTIVE: To evaluate the applicability of Chinese disseminated intravascular coagulation scoring system (CDSS) in the diagnose of DIC in patients with acute promyelocytic leukemia (APL) patients. METHODS: Medical records of 220 APL patients diagnosed and receiving induction therapy in Blood Disease Hospital, CAMS & PUMC from January 2004 to February 2018 were retrospectively analyzed. Each patient was evaluated by CDSS, the International Society of Thrombosis and Haemostais (ISTH) scoring system for overt DIC and Japanese Ministry of Health and Welfare (JMHW) scoring system for overt DIC, respectively. RESULTS: A total of 220 APL patients were enrolled in the study, with a median age of 38.5 (12–70) years, 114 male and 106 female. Among them, 173 were in the low-medium risk group, 47 high-risk group; 11 patients died during induction treatment. The positive rates of DIC diagnosed by CDSS criteria, ISHT criteria, JMHW criteria was 62.27%, 54.09%, 69.09%, respectively. The consistency rate of CDSS and ISTH in diagnosing DIC was 78.10%; the consistency rate of CDSS and JMHW was 88.32%. There was significant difference in PT, APTT, FIB, D-Dimer and FDP in DIC(+) and DIC(−) group by CDSS (all P<0.05), but patients in the DIC(+) group had lower level of D-Dimer than in the DIC(−) group [21.9(1.2–477.1) mg/L vs 26.3(0.6–488.7) mg/L, χ(2)=1.871, P=0.002] by ISTH, and there was not significant difference in APTT by JMHW [27.05(18.0–181.0) s vs 26.15(18.2–35.5) s, χ(2)=1.162, P=0.134]. In this study, both of the gender and age had no difference in the DIC(+) and DIC(−) group by CDSS. Univariate analysis showed that the level of WBC and the percent of abnormal promyelocytic cells in bone marrow when diagnosed were different in DIC(+) and DIC(−) group by CDSS (P<0.05). Multiple analysis showed the level of WBC (OR=3.525, 95% CI 1.875–6.629, P<0.001) was the only independent predictor in DIC diagnosis by CDSS. CONCLUSION: The sensitivity of diagnosing DIC by CDSS was higher than the ISTH; and the specificity was superior to JMHW. Using CDSS can help to make the DIC diagnosis and treatment in time for APL patients who with the coagulation abnormalities.