全球止血与即时检验。

Global haemostasis and point of care testing.

机构信息

Unite d'Hemostase Clinique, Hopital Edouard Herriot, EAM4174, Universite Lyon 1, Lyon, France.

出版信息

Haemophilia. 2012 Jul;18 Suppl 4:81-8. doi: 10.1111/j.1365-2516.2012.02855.x.

Abstract

The evaluation of the coagulation profile has used so far either clotting-based or chromogenic assays with different endpoints. Clotting-based techniques are the most used worldwide, and they certainly are useful for diagnosis of clotting factor deficiencies. However, the information provided is relatively limited, and therefore the individual profile of coagulation is poorly assessed. This is reflected by the weak correlation between the results of these assays and the clinical phenotype. Among the assays that benefited from technological advances, thrombin generation and thromboelastography are probably the most actively investigated, but they require specific instruments and are not fully automated. Their standardisation level is rapidly progressing, and they are progressively entering the clinical scene, with the attempt to provide additional information on the coagulation process and a meaningful clinical correlation. These inherited bleeding disorders frequently require replacement therapy using clotting factor concentrates that increase the plasma level of the missing clotting factor. The classical adjustment of the therapy is mainly based on the measurement of the plasma clotting activity of the protein administered. If one considers that a certain level of thrombin generated would predict clinical efficacy, monitoring of thrombin formation might offer new possibilities to individually predict the bleeding phenotype, select the most adapted therapeutic product and tailor the dose. The same holds true for thromboelastography/thromboelastometry which evaluate fibrin formation as well as clot resistance to fibrinolytic challenge, one step further down in the coagulation process. In this regard, these 2 assays could be seen as complementary in terms of information provided on the coagulation profile at the individual level.

摘要

目前,凝血谱的评估要么使用基于凝固的或显色的检测方法,终点不同。基于凝固的技术是全球应用最广泛的,它们对诊断凝血因子缺乏症当然是有用的。然而,所提供的信息相对有限,因此凝血的个体谱评估较差。这反映在这些检测结果与临床表型之间的弱相关性上。在受益于技术进步的检测方法中,凝血酶生成和血栓弹力图可能是研究最活跃的,但它们需要特定的仪器,并且不能完全自动化。它们的标准化水平正在迅速提高,并且正在逐步进入临床,试图提供关于凝血过程的额外信息和有意义的临床相关性。这些遗传性出血性疾病经常需要使用凝血因子浓缩物进行替代治疗,这些浓缩物会增加缺失的凝血因子在血浆中的水平。治疗的经典调整主要基于所给予蛋白质的血浆凝血活性的测量。如果认为一定水平的凝血酶生成将预测临床疗效,那么监测凝血酶形成可能会提供新的可能性,以个体预测出血表型,选择最适应的治疗产品,并调整剂量。血栓弹力图/血栓弹力测定也一样,它们评估纤维蛋白的形成以及纤维蛋白溶解挑战对凝块的抵抗力,这是凝血过程的进一步发展。在这方面,这两种检测方法可以被视为在个体水平上提供的凝血谱信息的互补方法。

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