活化部分凝血活酶时间的凝固曲线波形分析在鉴别血友病A和狼疮抗凝物阳性患者的临床应用研究  

Clinical application study of clot waveform analysis of activated partial thromboplastin time in discriminating between hemophilia A and lupus anticoagulant-positive patients

作　　者：韩立业 翟宏[1] 续薇[1] 俞秋阳 曲林琳[1] 黄晶[1] 安倍莹[1] Han Liye;Zhai Hong;Xu Wei;Yu Qiuyang;Qu Linlin;Huang Jing;An Beiying(Department of Laboratory Medicine,First Hospital of Jjilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院检验科,长春130021

出　　处：《中华检验医学杂志》2024年第8期920-926,共7页Chinese Journal of Laboratory Medicine

摘　　要：目的通过活化部分凝血活酶时间(APTT)的凝固曲线波形分析(CWA)快速鉴别血友病A(HA)和狼疮抗凝物(LA)阳性患者, 探讨APTT-CWA在HA和LA阳性患者中的诊断效能。方法收集2022年7月25日至2023年12月28日吉林大学第一医院就诊单独APTT延长患者145例, 其中男性106例, 女性39例, 年龄(29.3±15.8)岁, 临床明确诊断HA94例及LA阳性51例。采用Mann WhitneyU检验方法回顾性描述分析血友病A(HA)和狼疮抗凝物(LA)阳性患者APTT结果及其CWA参数的一阶导数最大反应速度|min1|、二阶导数的最大加速度|min2|和最大减速度|max2|的差异。依据APTT延长时间的不同将患者分为轻度延长(33 s<APTT≤43 s)、中度延长(43 s<APTT≤53 s)、重度延长(APTT>53 s)3组, 分别比较3组HA和LA阳性患者的APTT结果及CWA参数|min1|、|min2|和|max2|数值和图形有无差异。采用受试者工作特征(ROC)曲线下面积(AUC)评价CWA参数诊断效能并计算临界(cut-off)值。结果 HA患者和LA阳性患者APTT结果分别为70.2 s和41.5 s, 差异有统计学意义(P<0.001);HA患者和LA阳性患者CWA参数|min1|分别为1.459%/s和3.868%/s, |min2|分别为0.124%/s^(2)和0.502%/s^(2), |max2|分别为0.054%/s^(2)和0.388%/s^(2), 差异均有统计学意义(P<0.001)。在APTT延长的轻中重分组中, HA患者的CWA参数|min1|、|min2|和|max2|分别小于LA阳性患者的结果, 差异均有统计学意义(P<0.05)。CWA的一阶导数|min1|参数可视化为"速度曲线", |min1|值大小可视化曲线峰值的高低, HA患者的CWA图形|min1|峰值高度小于LA阳性患者, 在重度延长组中, HA患者的|min1|与LA患者相比较, 峰值减低更明显, 曲线平缓图形不完整。ROC曲线分析显示, 在APTT延长的轻中重分组中, |min1|、|min2|和|max2|的AUC均大于0.8(P<0.01);|min1|、|min2|和|max2|的cut-off值在轻度延长组分别为3.205%/s、0.423 %/s^(2)和0.300%/s^(2);中度延长组分别为2.884%/s、0.340%/s^(2)和0.231%/s^(2);重度延长组分别是为Objective:Clot waveform analysis(CWA)of activated partial thromboplastin time(APTT)was used to rapidly identify patients with hemophilia A(HA)and lupus anticoagulant(LA)positive,and to explore the diagnostic efficacy of APTT-CWA in HA and LA-positive patients.Methods:From July 25,2022,to December 28,2023,145 patients with APTT prolongation were admitted to the First Hospital of Jilin University.This group comprised 106 males and 39 females,with an average age of(29.3±15.8)years,among whom there were 94 clinically confirmed HA cases and 51 LA-positive cases.The retrospective analysis employed the Mann-Whitney U test to compare APTT results and CWA parameters between HA patients and LA-positive individuals.CWA parameters including the first derivative of maximum reaction velocity(|min1|),the second derivative of maximum acceleration(|min2|),and maximum deceleration(|max2|)were investigated.Patients were classified based on the duration of APTT prolongation into mild(33 s<APTT≤43 s),moderate(43 s<APTT≤53 s),and severe(APTT>53 s)groups.A comparison of APTT seconds and CWA parameters|min1|,|min2|,and|max2|was conducted for HA and LA-positive patients between each group.Furthermore,receiver operating characteristic(ROC)curves and area under the curve(AUC)were utilized to assess the diagnostic efficacy of CWA parameters and determine cut-off values.Results:The APTT results for HA and LA-positive patients were 70.2 s and 41.5 s,respectively,exhibiting a statistically significant difference(P<0.001).CWA parameters|min1|were 1.459%/s vs 3.868%/s,|min2|were 0.124%/s^(2) vs 0.502%/s^(2),and|max2|were 0.054%/s^(2) vs 0.388%/s^(2)in HA and LA patients,respectively(P<0.001).In all APTT prolongation groups,the CWA parameters|min1|,|min2|and|max2|for HA were significantly lower than those for LA-positive patients(P<0.05).CWA graph analysis revealed that the peak heights of|min1|,|min2|,and|max2|in HA were lower compared to LA patients.In the severe extension group,HA displayed significantly decreased peak values and a flatte

关 键 词：活化部分凝血活酶时间 凝固曲线波形分析 血友病A 狼疮抗凝物 

分 类 号：R446.11[医药卫生—诊断学]