Moore Gary W, Savidge Geoffrey F
Centre for Haemostasis and Thrombosis, Haemophilia Reference Centre, St Thomas' Hospital, London, UK.
Blood Coagul Fibrinolysis. 2004 Apr;15(3):279-82. doi: 10.1097/00001721-200404000-00015.
A number of studies have shown that commercial dilute Russell's viper venom time (DRVVT) reagents vary in their sensitivity for lupus anticoagulant (LA) detection. The differences in performance are considered to be predominantly due to antibody heterogeneity and a wide variation in phospholipid content, and also the techniques and clot detection methods employed. The present study compared the LA detection rates of five different Russell's viper venom (RVV) preparations using identical phospholipid reagents to assess the contribution of venom heterogeneity to LA detection by DRVVT. Initial analysis of 300 samples sent for thrombophilia screening identified 48 (16.0%) LAs by DRVVT and confirmatory tests with a single RVV reagent. Subsequent DRVVT analysis of all 300 samples using the other four venom reagents, with confirmatory tests on samples with elevated screen ratios, revealed a further 38 LAs in a variety of combinations of reagents. Only 15 of 86 (17.4%) of LAs were detected with all five RVV reagents. Significant biological variation of RVV exists due to differences between Russell's viper subspecies and a variety of environmental and physiological factors. The clear variations in diagnostic performance between alternative RVV preparations are most probably due to biological venom heterogeneity, and also differences in the manufacturing processes.
多项研究表明，市售稀释蝰蛇毒时间（DRVVT）试剂在检测狼疮抗凝物（LA）时的灵敏度存在差异。性能差异主要被认为是由于抗体异质性、磷脂含量的广泛变化，以及所采用的技术和凝血检测方法。本研究使用相同的磷脂试剂比较了五种不同蝰蛇毒（RVV）制剂的LA检测率，以评估毒液异质性对DRVVT检测LA的贡献。对300份用于血栓形成倾向筛查的样本进行初步分析，通过DRVVT和使用单一RVV试剂的确证试验确定了48例（16.0%）LA。随后使用其他四种毒液试剂对所有300份样本进行DRVVT分析，并对筛查比值升高的样本进行确证试验，结果在各种试剂组合中又发现了38例LA。在86例LA中，只有15例（17.4%）能被所有五种RVV试剂检测到。由于锯鳞蝰亚种之间的差异以及各种环境和生理因素，RVV存在明显的生物学变异。不同RVV制剂之间诊断性能的明显差异很可能是由于毒液的生物学异质性以及制造工艺的差异。
