Chest：弥散性血管内凝血的发病率下降

　　美国学者的一项研究显示，弥散性血管内凝血 （DIC）的发病率在过去10年间下降了，其中男性发病率下降更为明显，然而病死率仍保持不变。这与其他重症综合征的发展趋势一致，该发现可以改善卫生保健服务。  

　　该研究是一项人群为基础的回顾性队列研究，从2004年到2010年期间，持续在美国明尼苏达州的梅奥诊所纳入18岁以上的成年患者进行评估。DIC的诊断根据国际血栓与止血协会公开的DIC诊断方法。患者被分为肝素诱导的血小板减少症和血栓性血小板减少性紫癜，排除了肝功能Child Pugh分级为C级、任何一支的先天性和后天获得性凝血功能障碍的患者。 

　　结果显示，在入住ICU的8089例患者中，有154例患者符合DIC的诊断。整体DIC发病率从2004年的26.2/100000(95% CI, 17.1-38.4)下降到2010年的18.6/100000 (95% CI, 11.3-28.7)，DIC发病率在男性和女性中都随年龄增加，除了18-39年龄组外，其他年龄段的男性发病率更高。每年男性DIC发病率从2004年的41.6/100000(95% CI, 25.4-64.2)下降到2010年的21.2/100000(95% CI, 10.6 37.9) (P = .01)，女性发病率没有显著变化(P=0.79) 。研究期间内的病死率没有显著变化。

Trends in the incidence and outcomes of disseminated intravascular coagulation in critically ill patients (2004-2010): a population-based study.
BACKGROUND
The incidence and outcomes of disseminated intravascular coagulation (DIC) are incompletely defined. Therefore, we aimed to evaluate the trends in incidence and outcomes of critically ill patients with DIC.
METHODS
We conducted a population-based, retrospective cohort study evaluating consecutively admitted adult (≥ 18 years old) critically ill patients with DIC at the Mayo Clinic, Minnesota, from 2004 to 2010. DIC was diagnosed according to the International Society on Thrombosis and Hemostasis' overt DIC algorithm. Patients given a diagnosis of heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura, Child Pugh class C, or any known congenital or acquired coagulation disorders were excluded.
RESULTS
Of the 8,089 Olmsted County resident ICU admissions, a total of 154 patients met the DIC inclusion criteria. The overall incidence rate of DIC/100,000 person-years decreased from 26.2 (95% CI, 17.1-38.4) in 2004 to 18.6 (95% CI, 11.3-28.7) in 2010. The incidence rate of DIC increased with age in both men and women and was consistently higher in men, with the exception of the age group 18 to 39 years. The incidence rate/100,000 person-years of DIC in men decreased from 41.6 (95% CI, 25.4-64.2) in 2004 to 21.2 (95% CI, 10.6 37.9) in 2010 (P = .01), whereas in women, it did not change significantly (P = .79). The case fatality rate did not change significantly during the study period.
CONCLUSIONS
The incidence of DIC has decreased over the past decade, significantly in men, although the mortality rate remains the same. This is in agreement with trends in other critical care syndromes and could be attributable to improvements in health care delivery.