肝素诱导的血小板减少症的临床研究  

Clinical study of heparin-induced thrombocytopenia

作　　者：王京华[1] 王春颖[1] 谢蕊[3] 车德海[4] 贾瑞春[2] 鞠威[3] 苗美娟[2] 汪辉[2] 蒋燕[5] 仝东霞[2] 

机构地区：[1]哈尔滨医科大学附属第二医院血液科,150086 [2]哈尔滨医科大学附属第二医院输血科,150086 [3]哈尔滨医科大学附属第四医院 [4]哈尔滨医科大学附属肿瘤医院 [5]吉林大学中日联谊医院

出　　处：《中华血液学杂志》2011年第2期115-117,共3页Chinese Journal of Hematology

基　　金：黑龙江省自然科学基金（D2007-97）志谢：感谢加拿大Manehiu Poon教授（University of Calgary,Foothills Hospital）赠予HIT抗体阳性及阴性对照血清,并感谢加拿大赵滨生老师（University of Calgary,Foothills Hospital）提供技术指导.感谢哈尔滨医科大学附属第二医院血管外科姜维良主任及全体医生、护士在病例观察方面给予的支持与帮助

摘　　要：目的观察应用肝素治疗患者肝素诱导的血小板减少症（HIT）发病情况，探索血小板计数监测HIT的可行性及HIT抗体检测对HIT诊断的意义。方法对在血管外科应用普通肝素（UFH）治疗的145例患者进行临床观察，于应用UFH治疗前及治疗后进行血小板计数、HIT抗体ELISA检测及肝素诱导的血小板聚集试验（HIPA）等实验室检测。结果145例患者中血小板减少40例（27．6％），HIT抗体阳性59例（40．7％），HIPA阳性26例（17．9％），诊断HIT24例（16．5％），其中发生HIT并血栓形成综合征（HITTS）5例（发病率3．4％，占HIT患者的20．8％）。多数HIT患者（15例，62．5％）血小板减少与HIT抗体阳性、HtPA阳性同时发生。24例HIT患者的缸小板计数均在停用UFH后3～6d恢复到正常或达到用UFH前水平。结论通过动态监测血小板计数、联合HIT、抗体ELISA法检测及H1PA，可以早期诊断HIT，及时停用UFH，换用抗凝剂，HITTS的发生率有望进一步下降，减少致残、死亡的发生。Objective To observe the incidence of heparin-induced thrombocytopenia （HIT） in patients received unfractionated heparin （UFH） treatment, and explore the feasibility of monitoring HIT by platelet counts, as well as the significance of HIT-antibody test in HIT diagnosis. Methods 145 patients received UFH treatment in Vascular Surge~ Department were studied. Before and after the UFH treatment, platelet counts, HIT-antibody ELISA test and heparin-induced platelet aggregation （HIPA） were tested. Results Among the 145 patients, thromboeytopenia occurred in 40 （27.6%） cases, HIT-antibody ELISA test positive in 59（40.7% ） cases, HIPA test positive in 26（ 17.9% ） cases. The HIT was diagnosed in 24 （16.5%） cases, and heparin-induced thrombocytopenia and thrombosis （HITI＇S） occurred in 5 （3.4% in all cases, and 20.8% in HIT patients）. In HIT patients, 15 patients （62.5%） were thrombocytopenia, HIT- antibody positive and HIPA test positive. Platelet counts in all of the 24 patients recovered to normal or level before UFH treatment in 3 -6 days after heparin withdrawal therapy. Conclusion HIT can be early diagnosed by monitoring platelet counts, HIT-antibody ELISA test and HIPA test. Withdrawal of heparin therapy in time and use of alternative anticoagulant, HITFS rate might be expected to decline filrther.

关 键 词：肝素 血小板减少 HIT抗体 诊断 

分 类 号：R595.3[医药卫生—内科学]