抗血小板因子 4/肝素抗体对维持性血液透析患者的临床意义及危险因素：一项为期两年的前瞻性随访研究。
The clinical significance and risk factors of anti-platelet factor 4/heparin antibody on maintenance hemodialysis patients: a two-year prospective follow-up.
机构信息
Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease-2011DAV00088, Beijing, China.
出版信息
PLoS One. 2013 Apr 30;8(4):e62239. doi: 10.1371/journal.pone.0062239. Print 2013.
BACKGROUND
Heparin-induced thrombocytopenia is an immune response mediated by anti-PF4/heparin antibody, which is clinically characterized by thrombocytopenia and thromboembolic events. In this study, a prospective and multi-center clinical investigation 1) determined the positive rate of anti-PF4/heparin antibody in maintenance hemodialysis patients in China, 2) identified the related risk factors, and 3) further explored the effect of the anti-PF4/heparin antibody on bleeding, thromboembolic events, and risk of death in the patients.
METHODS
The serum anti-PF4/heparin antibody was measured in 661 patients from nine hemodialysis centers, detected by IgG-specific ELISA and followed by confirmation with excess heparin. Risk factors of these patients were analyzed. Based on a two-year follow-up, the association between the anti-PF4/heparin antibody and bleeding, thromboembolic events, and risk of death in the patients was investigated.
RESULTS
- The positivity rate of the anti-PF4/heparin antibody in maintenance hemodialysis patients was 5.6%. With diabetes as an independent risk factor, the positivity rate of the anti-PF4/heparin antibody decreased in the patients undergoing weekly dialyses ≥3 times. 2) The positivity rate of the anti-PF4/heparin antibody was not related to the occurrence of clinical thromboembolic events and was not a risk factor for death within two years in maintenance hemodialysis patients. 3) Negativity for the anti-PF4/heparin antibody combined with a reduction of the platelet count or combined with the administration of antiplatelet drugs yielded a significant increase in bleeding events. However, the composite determination of the anti-PF4/heparin antibody and thrombocytopenia, as well as the administration of antiplatelet drugs, was not predictive for the risk of thromboembolic events in the maintenance hemodialysis patients.
CONCLUSIONS
A single detection of the anti-PF4/heparin antibody did not predict the occurrence of clinical bleeding, thromboembolic events, or risk of death in the maintenance hemodialysis patients.
背景
肝素诱导的血小板减少症是一种由抗 PF4/肝素抗体介导的免疫反应，其临床特征为血小板减少和血栓栓塞事件。本研究进行了一项前瞻性、多中心临床研究：1）确定中国维持性血液透析患者抗 PF4/肝素抗体的阳性率，2）确定相关的危险因素，3）进一步探讨抗 PF4/肝素抗体对患者出血、血栓栓塞事件和死亡风险的影响。
方法
在来自 9 个血液透析中心的 661 例患者中检测血清抗 PF4/肝素抗体，采用 IgG 特异性 ELISA 检测，并用过量肝素进行确认。分析这些患者的危险因素。根据两年的随访，研究抗 PF4/肝素抗体与患者出血、血栓栓塞事件和死亡风险之间的关系。
结果
1）维持性血液透析患者抗 PF4/肝素抗体的阳性率为 5.6%。以糖尿病为独立危险因素，每周透析≥3 次的患者抗 PF4/肝素抗体的阳性率降低。2）抗 PF4/肝素抗体的阳性率与临床血栓栓塞事件的发生无关，也不是维持性血液透析患者两年内死亡的危险因素。3）抗 PF4/肝素抗体阴性但血小板计数减少，或联合使用抗血小板药物，会显著增加出血事件。然而，抗 PF4/肝素抗体和血小板减少的联合检测以及抗血小板药物的使用，并不能预测维持性血液透析患者的血栓栓塞事件风险。
结论
单次检测抗 PF4/肝素抗体不能预测维持性血液透析患者的临床出血、血栓栓塞事件或死亡风险。
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