1例肝素诱导的血小板减少症患者多学科诊疗分析  

Multidisciplinary diagnostic and therapeutic analysis of a patient with heparin-induced thrombocytopenia

作　　者：王鑫[1] 赵晓静 党琳 门剑龙[1] WANG Xin;ZHAO Xiaojing;DANG Lin;MEN Jianlong(Tianjin Medical University General Hospital Precision Medicine Center,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院精准医学中心,300052

出　　处：《天津医药》2025年第2期194-198,共5页Tianjin Medical Journal

基　　金：天津市科技计划项目(22JCQNJC00330)。

摘　　要：肝素诱导的血小板减少症(HIT)是一种由抗体介导的肝素不良反应,临床表现为在肝素给药后出现血小板计数进行性降低,严重者可导致静、动脉血栓栓塞甚至死亡。由于住院患者常见获得性血小板计数减少,病理机制多与药物、自身免疫性疾病以及消耗性减低相关,而发生HIT的患者往往自身临床情况复杂,其临床表现常不典型或与其他症状体征相互混杂,从而给医生诊断和治疗带来巨大的挑战。该文通过1例HIT患者的多学科诊疗过程,探讨了HIT的发生机制、临床评估、实验室检测和替代抗凝治疗等关键问题,以期为医生在临床上准确识别和有效干预提供参考。Heparin-induced thrombocytopenia(HIT)is an antibody-mediated adverse reaction to heparin that is clinically manifested as a progressive reduction in platelet count after heparin administration,leading to venous and/or arterial thromboembolism and even death in severe cases.Acquired thrombocytopenia is commonly observed in hospitalized patients,the pathological mechanism is associated with drugs,autoimmune diseases,and consumptive thrombocytopenia.Patients with HIT frequently have complex clinical situations,and their manifestations are often atypical or mixed with other symptoms and signs,posing significant challenges to diagnosis and treatment for clinicians.Through the multidisciplinary diagnosis and treatment process of a HIT patient,this paper discusses HIT occurrence mechanism,clinical evaluation,laboratory testing and alternative anticoagulant therapy,so as to provide reference for doctors to accurately identify and effectively intervention in clinical practice.

关 键 词：肝素 肝素诱导的血小板减少症 多学科诊疗 4Ts评分 抗PF_(4)-H抗体 阿加曲班 

分 类 号：R558.2[医药卫生—血液循环系统疾病]