改良Nijmegen法检测血友病因子Ⅷ抑制物的探讨  

Approach of Modified-Nijmegen in Detecting Factor Ⅷ:C Inhibitors of Hemophilia A

作　　者：王健琨 王华芳[1] 杨锐[1] 魏文宁[1] 刘小红 胡豫[1] 

机构地区：[1]华中科技大学同济医学院协和医院血液病研究所,武汉430022

出　　处：《血栓与止血学》2010年第6期269-271,共3页Chinese Journal of Thrombosis and Hemostasis

基　　金：卫生部部属(管)医疗机构临床学科重点项目(卫规财函【2007】353号);国家杰出青年科学基金项目(30825018)

摘　　要：目的评价改良Nijmegen法在检测血友病因子FⅧ抑制物中的应用,以确定改良Nijmegen法替代以往血友病抑制物检测方法的可能性。方法分别应用Nijmegen法和改良Nijmegen法测定79例血友病A患者血浆标本的FⅧ抑制物滴度。两种方法区别在于,改良Nijmegen法检测步骤中,患者血浆及乏因子Ⅷ血浆在与正常血浆37℃混合孵育前均经58℃水浴加热1.5 h。结果 Nijmegen法中有2例结果>0.5 BU,43例结果介于0.01～0.49 BU之间,34例为0;改进的Nijmegen法中有2例结果>0.5 BU,18例结果介于0.03～0.49 BU之间,59例为0。对两种方法中结果介于0～0.5 BU之间共计77例阴性和可疑阳性者进行卡方检验,应用改良Nijmegen法检测得到阴性检出率明显高于Ni-jmegen法(P<0.01);对于结果≥0.5 BU的病例,因样本数过少尚无法对两方法的检测结果进行统计学差别检验。结论样本经58℃水浴处理后能去除血浆标本原有FⅧ因子活性及其他因素的影响,使改良Nijmegen法有可能提高血友病抑制物检测的特异性,此方法有待于在更大样本量中进一步验证。Objective To estimate the possibility of modified-Nijmegen replacing the other assays in detecting factor Ⅷ:C inhibitors of hemophilia A. Methods Plasma specimens were drawn from 79 cases with hemophilia A;the FⅧ:C inhibitors tite of all specimens were measured by Nijmegen procedure and modified-Nijmegen procedure,respectively;the difference of two assays was that the case plasma and FⅧ-deficient control plasma were heated(58℃,1.5 h) before incubated(37℃,2 h) with normal pool plasma in modified-Nijmegen procedure. Results Using the consensual but arbitrary cut-off of 0.5 BU(Bethesda units),2 samples were judged positive(0.5 BU) by both procedures;34 samples were judged negative(=0 BU) by Nijmegen procedure compared with 59 samples judged by modified-Nijmegen procedure;43 samples were judged probable positive(Range: 0～0.5 BU) by Nijmegen procedure compared with 18 samples judged by modified-Nijmegen procedure.The negative detection rate of modified-Nijmegen was significant more than that of Nijmegen(P0.01). Conclusion Heating the test-and control plasma at 58℃ during 90 min will completely inactivate native FⅧ and other clotting factors so that the specificity of inhibitors detection may be improved by modified-Nijmegen which should be further validated in more samples.

关 键 词：改良 检测结果 血友病因子 因子Ⅷ抑制物 Approach 检测方法 血浆标本 样本数 抑制物滴度 阴性 水浴加热 水浴处理 卡方检验 检测步骤 患者 样本量 统计学 特异性 两方法 检出率 

分 类 号：R[医药卫生]