华法令和低分子肝素对狼疮抗凝物检测的干扰研究
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摘要
目的探讨口服华法令和肌肉注射低分子肝素(LMWH)对狼疮抗凝物(LA)检测的干扰。方法选择心脏瓣膜置换术后口服华法令和肾病透析肌肉注射LMWH患者各80例为研究对象(排除引起LA阳性疾病),对照组为健康体检者20例,检测各组LA比值,观察LA比值假阳性率。从口服华法令LA比值假阳性样本中随机选出20例,用健康人混合血浆1∶1稀释做混合试验,重新检测上述指标。结果口服华法令、肌肉注射LMWH各组筛选、确证试验时间均高于对照组,差异有统计学意义(P<0.01);且随着INR、LMWH抗Ⅹa活性增加,筛选、确证试验时间值及LA比值、LA比值假阳性率呈上升趋势。混合试验中,口服华法令组筛选、确证试验时间均高于对照组(P<0.01),LA比值差异无统计学意义(P>0.05),LA比值假阳性率均为0。结论口服华法令和肌肉注射LMHW对LA检测有较大干扰。
Objective To study the interference of oral warfarin and intramuscular injection of low molecular weight heparin(LMWH)on the lupus anticoagulant(LA)detection.Methods Each 80 patients with oral warfarin after heart valve replacement and 80 patients with intramuscular injection of LMWH due to nephropathy dialysis were selected as the study subjects(excluding the diseases causing LA positive).Twenty persons undergoing the physical examination served as the control group.The LA value in each group was detected.The false positive rate of LA ratio was observed.Then 20 cases were randomly selected from the LA ratio false positive samples in oral warfarin.The mixed test was conducted with healthy person mixed plasma1∶1 dilution.The above index was detected again.Results The time of screening test and time of confirmatory test in the oral warfarin group and intramuscular injection LMWH group were higher than those in the control group,and the difference was statistically significant(P<0.01),moreover,with the INR value and anti-Xa activity increase,the time of screening test and confirmatory test,LA ratio and LA ratio false positive rate showed the increasing trend.In the mixed test,the time of screening and confirmatory tests in the oral warfarin group were all higher than those in the control group(P<0.01),and the difference in the LA ratio had no statistical significance(P>0.05).The false positive rate of LA ratio was 0.Conclusion Oral warfarin and intramuscular injection of LMWH have great interference on LA detection.
Objective To study the interference of oral warfarin and intramuscular injection of low molecular weight heparin(LMWH)on the lupus anticoagulant(LA)detection.Methods Each 80 patients with oral warfarin after heart valve replacement and 80 patients with intramuscular injection of LMWH due to nephropathy dialysis were selected as the study subjects(excluding the diseases causing LA positive).Twenty persons undergoing the physical examination served as the control group.The LA value in each group was detected.The false positive rate of LA ratio was observed.Then 20 cases were randomly selected from the LA ratio false positive samples in oral warfarin.The mixed test was conducted with healthy person mixed plasma1∶1 dilution.The above index was detected again.Results The time of screening test and time of confirmatory test in the oral warfarin group and intramuscular injection LMWH group were higher than those in the control group,and the difference was statistically significant(P<0.01),moreover,with the INR value and anti-Xa activity increase,the time of screening test and confirmatory test,LA ratio and LA ratio false positive rate showed the increasing trend.In the mixed test,the time of screening and confirmatory tests in the oral warfarin group were all higher than those in the control group(P<0.01),and the difference in the LA ratio had no statistical significance(P>0.05).The false positive rate of LA ratio was 0.Conclusion Oral warfarin and intramuscular injection of LMWH have great interference on LA detection.
引文
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[6]PENGO V,TRIPODI A,REBER G,et al.Update of the guidelines for lupus anticoagulant detection[J].J Thromb Haemost,2009,7(10):1737-1740.
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[9]中华医学会心血管病学分会肺血管病学组.急性肺栓塞诊断与治疗中国专家共识[J].中华心血管杂志,2016,44(3):197-211.
[10]胡欢荣,李臣宾,周文宾,等.肝素抗凝治疗监测相关项目的性能验证[J].临床输血与检验,2017,19(3):252-257.
[11]FAVALORO E J,BONAR R,MARSDEN K.Internal quality control and external quality assurance in testing for antiphospholipid antibodies:part II-Lupus anticoagulant[J].Semin Thromb Hemost,2012,38(4):404-411.
[12]寿玮龄,陈倩,吴卫,等.改良蝰蛇毒磷脂时间试验和硅凝固时间试验检测狼疮抗凝物的性能验证[J].检验医学,2017,32(3):224-228.
[2]GRIS J C,BOUVIER S,NOUVELLON E,et al.Antiphosoholid antibodies and the risk of pregnancy complications[J].Thromb Res,2017,151(Suppl 1):34-37.
[3]饶绘,陈斌.狼疮抗凝物阳性结果的临床分析[J].临床输血与检验,2016,18(5):488-490.
[4]李洋,吕明恩,薛峰.狼疮抗凝物二例报告并文献复习[J].中华血液学杂志,2016,37(2):130-133.
[5]谢波,徐升强,崔天盆.狼疮抗凝物实验室规范化检测进展[J].临床检验杂志,2016,34(2):144-146.
[6]PENGO V,TRIPODI A,REBER G,et al.Update of the guidelines for lupus anticoagulant detection[J].J Thromb Haemost,2009,7(10):1737-1740.
[7]KEELING D,MACKIE I,MOORE G W,et al.Guidelines on the investigation and management of antiphospholipid syndrome[J].Br J Haematol,2012,157(1):47-58.
[8]寿玮龄,陈倩,吴卫,等.不同狼疮抗凝物检测试验的临床诊断效能研究[J].中华医学杂志,2015,95(34):2760-2765.
[9]中华医学会心血管病学分会肺血管病学组.急性肺栓塞诊断与治疗中国专家共识[J].中华心血管杂志,2016,44(3):197-211.
[10]胡欢荣,李臣宾,周文宾,等.肝素抗凝治疗监测相关项目的性能验证[J].临床输血与检验,2017,19(3):252-257.
[11]FAVALORO E J,BONAR R,MARSDEN K.Internal quality control and external quality assurance in testing for antiphospholipid antibodies:part II-Lupus anticoagulant[J].Semin Thromb Hemost,2012,38(4):404-411.
[12]寿玮龄,陈倩,吴卫,等.改良蝰蛇毒磷脂时间试验和硅凝固时间试验检测狼疮抗凝物的性能验证[J].检验医学,2017,32(3):224-228.