肝素诱导性血小板减少症41例临床分析  

Clinical analysis of 41 cases of heparin-induced thrombocytopenia

作　　者：范庆坤[1] 陈晓英[1] 刘彬[1] 刘成伟[1] 肖红艳[1] 杨军[1] 张李涛[1] 张真路[1] 

机构地区：[1]武汉亚洲心脏病医院,武汉430021

出　　处：《内科急危重症杂志》2017年第1期18-22,39,共6页Journal of Critical Care In Internal Medicine

基　　金：武汉市卫计委科研基金(WX16D40);武汉亚洲心脏病医院创新基金(2015CX3-B15)

摘　　要：目的:探讨肝素诱导性血小板减少症(HIT)的诊疗要点。方法:回顾性分析187例疑似HIT患者,根据美国胸科医师学会(ACCP)发布的第9版HIT诊断标准分为HIT组和非HIT组,观察并记录2组患者的血小板计数(PLTc)、HIT抗体检测结果、4Ts评分、血栓并发症、HIT临床用药以及转归。结果:确诊HIT患者41例(21.9%),非HIT患者146例。深静脉血栓发生率HIT组(36.6%,15/41)明显高于非HIT组(18.5%,27/146)(P=0.0250)。血小板计数(PLTc)的最低绝对值(29.3±13.2)×10~9/L明显低于非HIT组(P=0.0170)。PLTc下降幅度(83.8%)、4Ts评分(5分)、HIT抗体浓度(3.1 U/m L)均明显高于非HIT组(P=0.0267,P<0.0001和P<0.0001)。确诊HIT患者均停用普通肝素,其中31例HIT患者使用替代抗凝药(阿加曲班27例)。结论:血小板计数和HIT抗体检测是疑似HIT鉴别诊断的指标,一旦高度怀疑HIT,应立即停用肝素。Objective： To study the management of heparin-induced thrombocytopenia（ HIT）,and to establish the diagnostic procedure for HIT in the Chinese population. Methods： We made a retrospective analysis on 187 cases of suspected HIT in our hospital who received continuous diagnosis and treatment from July 2012 to December 2015. The patients were divided them into HIT group and non-HIT group according to the 9th edition of HIT diagnostic criteria published by ACCP,and the platelet count（ PLTc）,HIT antibody concentration,4T score,thrombotic complications,clinical treatments and prognosis of the patients were recorded. Results： Among the patients with suspected HIT,41（ 21. 9%） cases were suffered from HIT,and 146 cases were excluded. The incidence of deep venous thrombosis in the HIT group（ 36.6%,15 / 41） was significantly higher than in the non-HIT group（ 18.5%,27 / 146）（ P = 0.0250）. The minimum absolute value of PLTc（ 29.3±13.2） ×10-9/ L in the HIT group was significantly lower than in the non-HIT group（ P = 0.0170）,whereas the decreasing rate of PLTc（ 83.8%）,4T score（ 5 points）,and HIT antibody concentration（ 3. 10 U / m L） in the HIT group were significantly higher than in the non-HIT group（ P = 0.0267,P〈0.0001 and P〈0.0001 respectively）. Patients with confirmed HIT stopped applying UFH,and 31 of them accepted other anticoagulant for substitute（ 27 cases using argatroban）. Conclusion： PLTc and HIT antibody concentration are indicators for HIT diagnosis. Once the patient with a high suspicion of,or proven,HIT,heparin should be stopped immediately.

关 键 词：肝素 血小板减少 HIT抗体 阿加曲班诊断 

分 类 号：R558[医药卫生—血液循环系统疾病]