狼疮抗凝物阳性脑梗死患者实验室检查及临床特点分析  

Laboratory examination and clinical characteristics of patients with ischemic stroke of positive lupus anticoagulant

作　　者：张丽敏[1] 赵可欣 王丹[1] 孙越红[1] 张晨曦 姜华[1] 李虓[1] 王冬至 张国军[1] Zhang Limin;Zhao Kexin;Wang Dan;Sun Yuehong;Zhang Chenxi;Jiang Hua;Li Xiao;Wang Dongzhi;Zhang Guojun(Laboratory Diagnosis Center,Beijing Tiantan Hospital Affiliated to Capital Medical University&Beijing Engineering Research Center of Immunological Reagents Clinical Research&National Medical Products Administration Key Laboratory for Quality Control of In Vitro Diagnostics,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院、北京市免疫试剂临床工程技术研究中心、国家药监局体外诊断试剂质量控制重点实验室,北京100070

出　　处：《中国综合临床》2022年第6期515-521,共7页Clinical Medicine of China

基　　金：北京天坛医院院青年科研基金(2016-YQN-09);首都医科大学科研培育基金(PYZ2017067)。

摘　　要：目的分析狼疮抗凝物(lupus anticoagulant,LA)阳性脑梗死患者实验室检查及临床特点。方法选取2016年1月至2021年10月北京天坛医院住院治疗的脑梗死患者216例临床资料进行回顾性分析,根据LA在脑梗死患者中的检出情况,将患者分为LA阳性脑梗死组(168例)和LA阴性脑梗死组(48例),对比两组患者间的实验室检测数据,并且纳入脑梗死相关危险因素,包括体质量指数(body mass index,BMI)、吸烟史、饮酒史、高血压、高血脂、糖尿病病史等进行比较分析。LA分别采用二氧化硅凝固时间(silica clotting time,SCT)法和改良的稀释蝰蛇毒时间(diluted russell viper venom time,dRVVT)法进行检测。将LA阳性脑梗死组根据阳性检出情况分为3个亚组,分别为dRVVT单阳组(110例),SCT单阳组(40例)及dRVVT、SCT双阳组(18例),并进行不同亚组间实验室指标比较。正态分布的计量资料两组间比较采用独立样本t检验,多组间比较采用方差分析;不符合正态分布的计量资料组间比较采用秩和检验,计数资料组间比较采用χ^(2)检验。结果LA阳性组脑梗死患者抗凝血酶Ⅲ和蛋白C水平[(102.85±14.39)%、(108.52±22.62)%]低于LA阴性组[(110.16±11.10)%、(116.34±18.14)%],差异均有统计学意义(t值分别为3.25、2.20,P值分别为0.001、0.029)。LA阳性组纤维蛋白原、同型半胱氨酸、超敏C反应蛋白、红细胞沉降率、白细胞和中性粒细胞水平[3.43(3.07,4.03)g/L、17.92(14.07,23.71)μmol/L、6.97(2.33,11.46)mg/L、15.00(6.75,29.00)mm/h、8.61(6.72,10.86)×10^(9)/L、5.81(4.39,7.91)×10^(9)/L]高于LA阴性组[3.14(2.68,3.62)g/L、14.62(12.49,18.41)μmol/L、3.18(2.09,4.32)mg/L、9.50(3.75,19.00)mm/h、7.20(6.22,8.33)×10^(9)/L、4.47(4.02,5.57)×10^(9)/L],差异均有统计学意义(Z值分别为2.77、2.89、3.32、2.45、3.15和3.76;P值分别为0.006、0.004、0.001、0.014、0.002和<0.001)。而年龄、性别、BMI、个人史、既往病史以及其他实验室指标两组间Objective To analyze the laboratory tests and clinical characteristics of patients with lupus anticoagulant-positive cerebral infarction.Methods A retrospective analysis of 216 patients with cerebral infarction hospitalized in Beijing Tiantan Hospital from January 2016 to October 2021 was performed,and the patients were divided into LA-positive cerebral infarction group(168 cases)and LA-negative cerebral infarction group(48 cases)according to the detection of lupus anticoagulant(LA)in cerebral infarction patients,and the laboratory test data between the two groups were compared,and the risk factors related to cerebral infarction,including body mass index(BMI),smoking history,drinking history,hypertension,hyperlipidemia,diabetes history,were included for comparative analysis.LA was performed using the silica clotting time(SCT)method and the modified diluted russell viper venom time(dRVVT)method,respectively.The dRVVT method was used to detect LA.The LA-positive cerebral infarction group was divided into three subgroups according to the positive detection,namely,the dRVVT single-positive group(110 cases),the SCT single-positive group(40 cases)and the double-positive group(18 cases),and the comparison of laboratory indices between different subgroups was performed.The measurement data of normal distribution between the two groups were compared by independent sample t-test,and the mean between multiple groups was compared by ANOVA;The rank sum test was used to compare the median between the measurement data groups that did not conform to the normal distribution,and theχ2 test was used to compare the counting data groups.Results The levels of antithrombinⅢand protein C of the LA-positive group((102.85±14.39)%and(108.52±22.62)%)were all lower than those of the LA-negative group((110.16±11.10)%and(116.34±18.14)%),the difference was statistically significant(t values were 3.25,2.20,P values were 0.001,0.029,respectively).The levels of fibrinogen,homocysteine,high-sensitivity C-reactive protein(hs-CRP),erythrocyte

关 键 词：狼疮抗凝物 脑梗死 血栓 凝血 

分 类 号：R743.33[医药卫生—神经病学与精神病学]