摘要
目的探讨HIT-Ab检测对疑似肝素诱导血小板减少症(HIT)新发血栓预测价值。方法回顾性队列研究。连续收集2016年7月至2018年11月疑似HIT472例,所有对象进行4Ts评分并送检HIT-Ab。依HIT-Ab结果分为四组:阴性组(0~0.9U/ml)412例、弱阳性组(1.0~4.9U/ml)45例、中阳性组(5.0~15.9U/ml)12例和强阳性组(≥16.0U/ml)3例。以超声或CT扫描检查确诊新发血栓为标准,评估HIT-Ab对新发血栓预测价值,以临床确诊HIT为标准评估HIT-Ab对HIT诊断效能。结果各组中新发血栓的发生率分别为:阴性组15.8%(62/412)、弱阳性组48.9%(22/45)、中阳性组75.0%(9/12)和强阳性组100%(3/3)(P<0.00)。HIT-Ab≥1.0U/ml时,诊断新发血栓的特异性93.0%,敏感性34.3%,阴性预测值(NPV)84.2%,阳性预测值(PPV)56.5%。各组HIT确诊率为:阴性组0%(0/412),弱阳性组62.2%(28/45),中阳性组(12/12)和强阳性组(3/3)均为100%,(P<0.00)。HIT-Ab≥1.0U/ml时,对HIT诊断特异度96.0%,敏感度100%,NPV100%,PPV71.5%。结论HIT-Ab在疑似HIT患者中,新发血栓发生率随HIT-Ab水平升高而增高。HIT-Ab检测可作为疑似HIT患者新发血栓预测和HIT诊断的重要工具。临床医生可依据HIT-Ab水平制定治疗策略。
Objective To investigate the predictive value of HIT-antibodies(HIT-Ab) detection for new thrombus in suspected Heparin-Induced thrombocytopenia (HIT). Methods Retrospective cohort study. 472 suspected HIT patients were collected from July 2016 to November 2018, and all subjects underwent a 4Ts score and were sent for HIT-Ab tests. According to the results of HIT-Ab, there were four groups: 412 cases of negative HIT-Ab (0-0.9 U/ml), 45 cases of weak-positive HIT-Ab (1.0-4.9 U/ml), 12 cases of moderate-positive HIT-Ab (5.0-15.9 U/ml), and 3 cases of strong-positive HIT-Ab (≥16.0 U/ml) respectively. Ultrasound or CT examination was used to confirm new thrombosis as a standard to evaluate the value of HIT-Ab for predicting new thrombus. The diagnostic efficacy of HIT-Ab for HIT was evaluated in clinically confirmed HIT. Results The incidence rates of new thrombus in each group were: 15.8% in Negative HIT-Ab group (62/412), 48.9% in Weak-positiveHIT-Ab group (22/45), 75.0% in Moderate-positive HIT-Ab group (9/12), and100% in Strong-positive HIT-Ab group (3/3)(P<0.00). When HIT-Ab≥1.0 U/ml, the specificity for diagnosing new thrombus was 93.0%, the sensitivity was 34.2%, the negative predictive value (NPV) was 84.2%, and the positive predictive value (PPV) was 56.5%. The diagnostic rates of HIT in each group were: negative 0%(0/412), weak-positive 62.2%(28/45), moderate-positive (12/12) and strong-positive (3/3) were 100%. When HIT-Ab ≥ 1.0 U/ml, the specificity for HIT diagnosis was 96.0%, the sensitivity was 100%, NPV was 100%, and PPV was 71.5%. Conclusions In suspected HIT patients, the incidence of new thrombosis increases with the elevated HIT-Ab level. HIT-Ab detection can be used as a crucial tool for new thrombosis prediction and HIT diagnosis in suspected HIT patients. Clinicians can develop treatment strategies based on HIT-Ab levels.
作者
范庆坤
杜佳
李玲
胡元萍
刘晓辉
张李涛
杨军
李莎
吴明祥
张真路
Fan Qingkun;Du Jia;Li Ling;Hu Yuanping;Liu Xiaohui;Zhang Litao;Yang Jun;Li Sha;Wu Mingxiang;Zhang Zhenlu(Department of Laboratory Medicine, Wuhan Asia Heart Hospital, Wuhan 430021,China;Cardial Surgery Department, Wuhan Asia Heart Hospital, Wuhan 430021,China;Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430021,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2019年第4期250-254,共5页
Chinese Journal of Laboratory Medicine
基金
湖北省卫生健康委员会科研项目(WJ2019F025)
武汉市卫计委科研项目(WX18B02)
武汉亚洲心脏病医院医院创新基金(2017CX4-A02)。
关键词
血小板减少
自身抗体
肝素
静脉血栓形成
预测
Thrombocytopenia
Autoantibodies
Heparin
Venous thrombosis
Forecasting
