摘要
目的:分析凝血因子Ⅷ抑制物阳性血友病患者APTT纠正试验结果,提高APTT纠正试验在凝血因子Ⅷ抑制物筛查中的价值。方法:收集并稀释制备不同滴度凝血因子Ⅷ抑制物血浆80份进行常规的即刻及37℃孵育2 h APTT纠正试验,选取15份样本进行即刻和常温孵育15 min、30 min、1和2 h及37℃孵育30 min、1和2 h APTT纠正试验。结果:APTT纠正试验结果与凝血因子Ⅷ抑制物滴度呈明显的相关性,ROC曲线下37℃孵育2 h APTT纠正试验判断有无凝血因子Ⅷ抑制物最佳诊断界点是43.8 s(敏感度85.90%,特异度100%),区分高滴度与低滴度Ⅷ抑制物的最佳诊断界点为52.4 s(敏感度98.18%,特异度95.65%)。即刻APTT无法纠正的临界凝血因子Ⅷ抑制物滴度为5.14 BU/ml,37℃孵育2 h APTT不能纠正对应的凝血因子Ⅷ抑制物的滴度为1.31 BU/ml。对不同时间和温度下APTT纠正试验结果进行配对t检验,差异有统计学意义(P<0.05)。结论:APTT纠正试验结果可作为凝血因子Ⅷ抑制物的筛查指标,较低Ⅷ抑制物滴度时呈明显的对温度-时间的依赖性,血友病患者即刻APTT无法纠正则应警惕较高滴度凝血因子Ⅷ抑制物存在的可能。
Objective:To analyze the results of activated partial thromboplastin time(APTT) mixing test in coagulation factor Ⅷ inhibitor-positive hemophilia patients,so as to increase the value of APTT mixing test in the screen of factor Ⅷ inhibitor.Methods:Eighty plasmas samples with different titers of coagulation factor Ⅷ inhibitors had been collected and diluted for routine immediate APTT mixing test and at 37 ℃ 2 hours incubation APTT mixing test.Fifteen samples were selected for immediate and normal temperature incubation for 15 min,30min,1 hour,2 hours and 37 ℃ for 30 min,1 hour,2 hours APTT mixing test.Results:The results of APTT mixing test were significantly correlated with the titers of coagulation factor Ⅷ inhibitors.The ROC curve result showed that the best diagnostic cutoff value for 2 hours incubation APTT mixing test at 37 ℃ to determine the presence or absence of coagulation factor Ⅷ inhibitors was 43.8 s(sensitivity and specificity was 85.90% and 100%,respectively),while the best diagnostic cutoff value for distinguishing high-titer and low-titer Ⅷ inhibitors was 52.4 s(sensitivity and specificity was 98.18% and 95.65%,respectively).The critical coagulation factor Ⅷ inhibitor titer that could not be corrected by immediate APTT was 5.14 BU/ml,while that could not be corrected by 37 ℃ 2 hours incubation APTT was 1.31 BU/ml.Paired samples t-test was performed on the APTT mixing test results at different times and temperatures,and the differences were statistically significant(P<0.05).Conclusions:The APTT mixing test can be used as a screening index for coagulation factor Ⅷ inhibitors.APTT mixing test result shows a significant time-temperature dependence with lower titers of coagulation factor Ⅷ inhibitor.Patients with hemophilia who cannot be corrected by immediate APTT mixing test should be alert to the possibility of high titer of coagulation factor Ⅷ.
作者
张丽华
谢智强
庄和
王梅华
曹颖平
ZHANG Li-Hua;XIE Zhi-Qiang;ZHUANG He;WANG Mei-Hua;CAO Ying-Ping(Department of Clinical Laboratory Examination,Fujian Medical University Union Hospital,Fuzhou 350001,Fujian Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2023年第6期1791-1796,共6页
Journal of Experimental Hematology
