生物学检测及4T评分在肝素诱导的血小板减少症诊断中的作用
Contributions of biological tests and the 4 Ts score in the diagnosis of heparin induced thrombocytopenia.
作者信息
Haouach Khalil, Admou Brahim, Lauriant Pascal, Chabaa Laila
机构信息
Laboratory of hematology, Faculty of Medicine, Cadi Ayyad University, University Hospital, Marrakech, Morocco.
出版信息
Pan Afr Med J. 2012;13:9. Epub 2012 Sep 12.
INTRODUCTION
Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction caused by antibodies to the heparin/platelet factor 4 (PF4) complexes. HIT diagnosis is challenging and depends on clinical presentation and laboratory tests. We investigated the interest of the combined use of 4 Ts score and the functional and immunological tests for the diagnosis of HIT.
METHODS
We analyzed 178 patients with suspected HIT, for which the 4 Ts score was calculated. Heparin-PF4 antibodies were detected by both Heparin-induced platelet activation test (HIPA) and Heparin platelet induced antibodies enzyme immunoassay.
RESULTS
Our results shown that in low probability group, 85% of plasmas were found negative versus 55.5% in the high probability group. On the other hand, 22.2% of patients were HIT positive in high probability group versus 0% in the low probability group.
CONCLUSION
These results confirmed that the negative predictive value of the HIT score was high. The 4T's model has demonstrated excellent sensitivity but its specificity was limited. The specificity of the functional and immunological test is high only in a context suggestive of HIT. Both methods should be considered complementary in the diagnostic strategy.
引言
肝素诱导的血小板减少症（HIT）是一种由针对肝素/血小板因子4（PF4）复合物的抗体引起的药物不良反应。HIT的诊断具有挑战性，依赖于临床表现和实验室检查。我们研究了联合使用4Ts评分以及功能和免疫检测对HIT诊断的价值。
方法
我们分析了178例疑似HIT患者，计算其4Ts评分。通过肝素诱导的血小板激活试验（HIPA）和肝素血小板诱导抗体酶免疫测定法检测肝素-PF4抗体。
结果
我们的结果显示，在低概率组中，85%的血浆检测为阴性，而高概率组中这一比例为55.5%。另一方面，高概率组中22.2%的患者HIT检测呈阳性，而低概率组中这一比例为0%。
结论
这些结果证实HIT评分的阴性预测值较高。4T模型显示出极佳的敏感性，但其特异性有限。功能和免疫检测仅在提示HIT的情况下特异性较高。在诊断策略中，这两种方法应被视为互补。
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