Japanese

Title	敗血症DICの診断および病態把握における血液凝固マーカー検査の重要性を考える
Subtitle	第25回日本検査血液学会学術集会 教育講演3
Authors	梅村穣
Authors (kana)
Organization	大阪急性期・総合医療センター救急診療科
Journal	日本検査血液学会雑誌
Volume	25
Number	3
Page	449-455
Year/Month	2024 / 11
Article	報告
Publisher	日本検査血液学会
Abstract	「要旨」敗血症性播種性血管内凝固(DIC)は頻度, 重症度ともに高い最重要臨床課題の一つである. DICは全身性の凝固システムの亢進と好中球 - 血小板 - 血管内皮の相互作用が複雑に関与したメカニズムで発症し, その診断, 治療判断には種々の血液凝固指標を組み合わせて行う必要がある. 現在, 我が国の臨床現場で使用されているDIC診断基準の多くは, 血小板数やProthrombin時間などの血液凝固マーカーを中心として構成されている. またTATやPICなどの血液分子マーカーを用いることで基礎疾患に応じて異なるDICの病型を詳細に評価できることも期待され, 2017年に血栓止血学会より提唱された新しいDIC診断基準では血液分子マーカーを診断項目の一つとして取り入れた. また血栓性微小血管症やヘパリン起因性血小板減少症などのDICと類似の臨床像をきたす疾患と適切に鑑別を行う場合にも血液凝固マーカーの評価は最重要視されている. 敗血症における抗凝固療法の有効性はDICの有無, 重症度によって異なる可能性があり, 治療対象を適切に選定することが重要である. 血液凝固マーカーの推移から抗凝固療法の適切な時期を検討することも, その有効性に関与する重要な要素であり, 最適な治療戦略を確立するためには, 今後も研究を進めていく必要がある.
Practice	臨床医学：一般
Keywords	敗血症, 播種性血管内凝固, 診断基準, 血液凝固マーカー, 抗凝固療法, Sepsis, Disseminated intravascular coagulation, Diagnostic criteria, Biomarkers, Anticoagulant therapy

English

Title	Importance of Blood Coagulation Markers in Diagnosis and Management of Sepsis DIC
Subtitle
Authors	Yutaka Umemura
Authors (kana)
Organization	Osaka General Medical Center, Division of Trauma and Surgical Critical Care
Journal	Journal of the Japanese Society for Laboratory Hematology
Volume	25
Number	3
Page	449-455
Year/Month	2024 / 11
Article	Report
Publisher	The Japanese Society for Laboratory Hematology
Abstract	[Abstract] Sepsis-induced disseminated intravascular coagulation (DIC) is one of the most important clinical issues with high frequency and severity. DIC develops by a mechanism in which systemic activation of the coagulation system and interaction between neutrophils, platelets, and vascular endothelium are intricately involved. It is thus necessary to combine various blood coagulation biomarkers for diagnosis and management. Currently, most of the DIC diagnostic criteria used in clinical practice in Japan are primarily composed of blood coagulation biomarkers, such as the platelet count and prothrombin time. In addition, it is expected that the use of blood molecular markers, such as thrombin-antithrombin complex (TAT) and alpha2-plasmin inhibitor-plasmin complex (PIC), will enable detailed evaluation of the phenotypes of DIC depending on the underlying disease. In 2017, new DIC diagnostic criteria proposed by the Japanese Society on Thrombosis and Hemostasis incorporated blood molecular markers as one of the diagnostic items. In addition, the evaluation of blood coagulation markers is of the utmost importance when appropriately differentiating from diseases with a clinical picture resembling DIC, such as thrombotic microangiopathy and heparin-induced thrombocytopenia. The effectiveness of anticoagulation therapy for sepsis may vary depending on the presence or severity of DIC, and it is important to select an appropriate target for treatment. Determining the appropriate timing of anticoagulant therapy based on the evolution of blood coagulation markers is also an important factor involved in its effectiveness, and research needs to be conducted in the future to establish optimal treatment strategies.
Practice	Clinical medicine
Keywords	Sepsis, Disseminated intravascular coagulation, Diagnostic criteria, Biomarkers, Anticoagulant therapy

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