Evaluation of Activated Partial Thromboplastin Time Mixing Studies Using Several Methods
Evaluation of Activated Partial Thromboplastin Time Mixing Studies Using Several Methods
复制标题
使用多种方法评估活化部分凝血活酶时间混合研究
DOI：
10.5858/arpa.2021-0123-oa
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发表时间：
2022-11-01
影响因子：
4.6
通讯作者：
Zhou, Jing
中科院分区：
文献类型：
--
作者：
Liu, Chaonan;Ling, Liqin;Zhou, Jing
背景：激活的部分凝血活酶时间(APTT)延长，这是一种重要的凝血筛查试验，可能是由于凝血因子的缺乏以及因子抑制剂或抗磷脂抗体的存在。正在优化APTT混合研究，以帮助找到原因。目标。为了优化APTT混合研究，我们评估了现有标准，并探索了何时以及如何结合1：1和4：1混合。设计-APTT延长但其他方面凝血酶原时间和凝血酶时间正常的患者在2018年1月1日至2019年12月31日在该院登记。所有样本进行1：1混合研究，134个样本进行4：1混合研究。结果：共纳入251份样本，其中116份为因子缺乏，75份为FVIII抑制剂，60份为抗磷脂抗体。Rosner指数小于11%或孵育时间延长超过3秒，在区分因子缺乏症和抑制剂以及区分时间依赖的抑制剂和时间非依赖的抑制剂方面优于其他现有标准，但本文提出的方法在这些方面有所改进。若要获得最佳的诊断准确性，Rosner指数在5.0%至9.1%之间的样本需要进行4：1的混合试验，而其他样本则需要1：1。Rosner指数和孵育时间-P的组合似乎为解释结果提供了客观而有效的标准。结论：APTT混合试验在区分因子缺陷与抑制剂、或时间依赖性与时间非依赖性抑制剂方面具有良好的敏感性和特异性。1：1和4：1混合试验相结合较单独1：1试验更能提高诊断能力。
Context.-A prolonged activated partial thromboplastin time (APTT), a vital screening test for coagulation, can be due to deficiencies in coagulation factors and the existence of factor inhibitors or antiphospholipid antibodies. APTT mixing studies are being optimized to help find the cause.Objective.-To optimize APTT mixing studies, we evaluated existing standards and explored when and how to combine 1:1 and 4:1 mixing.Design.-Patients with a prolonged APTT but otherwise normal prothrombin time and thrombin time were enrolled in our hospital from January 1, 2018, to December 31, 2019. All samples were subjected to 1:1 mixing studies, while 134 were subjected to 4:1.Results.-A total of 251 samples were involved, including 116 with factor deficiencies, 75 with FVIII inhibitors, and 60 with antiphospholipid antibodies. A Rosner index less than 11% or an extended incubation time of more than 3 seconds was better than other existing standards in differentiating factor deficiencies from inhibitors and in differentiating time-dependent inhibitors from time-independent inhibitors, but the approach presented here improves upon those. For the best diagnostic accuracy, samples with a Rosner index between 5.0% and 9.1% need a 4: 1 mixing study, while others need 1:1. A combination of Rosner index and percent-extended incubation time-P seemed to offer objective and effective criteria for interpreting the results.Conclusions.-APTT mixing studies had overall good sensitivity and specificity in differentiating factor deficiencies from inhibitors, or time-dependent from time-independent inhibitors. The combination of 1:1 and 4:1 mixing studies can improve the diagnostic ability compared with 1:1 alone.