血小板微粒生成检测：一种用于免疫性肝素诱导的血小板减少症诊断的重要检测方法。
Platelet microparticle generation assay: a valuable test for immune heparin-induced thrombocytopenia diagnosis.
作者信息
Mullier F, Minet V, Bailly N, Devalet B, Douxfils J, Chatelain C, Elalamy I, Dogné J M, Chatelain B
机构信息
Hematology Laboratory- Namur Research Institute for LIfe Sciences (NARILIS), CHU Dinant-Godinne UCL Namur, Yvoir, Belgium; Department of Pharmacy- Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium; Namur Thrombosis and Hemostasis Center (NTHC), Namur, Belgium.
Department of Pharmacy- Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium.
出版信息
Thromb Res. 2014 Jun;133(6):1068-73. doi: 10.1016/j.thromres.2013.12.009. Epub 2013 Dec 9.
BACKGROUND
Early diagnosis of immune heparin-induced thrombocytopenia (HIT) is essential to improve clinical outcome but remains challenging. The release of platelet microparticles (PMPs) is considered of major pathophysiological significance.
OBJECTIVES
The aim of this study was to evaluate performances of PMP generation assay (PMPGA) compared to clinical outcome to diagnose HIT. The second objective was to compare PMPGA with performances of (14)C-serotonin release assay (SRA) on the same series of patients.
METHODS
Sera of 53 HIT-suspected patients were retrospectively incubated with citrated-whole blood from healthy donors with 1IU and 500IU/ml of unfractionated heparin (UH). PMPGA was performed using FACSAria® flow cytometer. The clinical diagnosis was established by two blinded independent investigators analysing in a standardized manner the patient's medical records. Performances of PMPGA and SRA (n=53) were evaluated using ROC curve analysis with clinical outcome as reference.
RESULTS
In positive HIT patients, PMPs expressing phosphatidylserine are generated with low UH concentration whereas PMP rate decreases significantly in presence of high UH concentration. Using clinical outcome as reference, sensitivity and specificity of PMPGA reached 88.9% (95% CI: 50.7-99.4) and 100.0% (95% CI: 90.0-100.0). Sensitivity and specificity of (14)C-SRA were 88.9% (95% CI: 50.7-99.4) and 95.5% (95% CI: 83.3-99.2).
CONCLUSIONS
PMPGA is a rapid and reliable assay for HIT diagnosis. PMPGA showed good correlation with (14)C-SRA performances and predominately with clinical outcome.
背景
免疫性肝素诱导的血小板减少症（HIT）的早期诊断对于改善临床结局至关重要，但仍具有挑战性。血小板微粒（PMPs）的释放被认为具有重要的病理生理学意义。
目的
本研究旨在评估与临床结局相比，PMP生成试验（PMPGA）在诊断HIT方面的性能。第二个目的是在同一组患者中比较PMPGA与¹⁴C-血清素释放试验（SRA）的性能。
方法
回顾性地将53例疑似HIT患者的血清与来自健康供者的枸橼酸盐全血在1IU和500IU/ml的普通肝素（UH）存在下进行孵育。使用FACSAria®流式细胞仪进行PMPGA。由两名独立的盲法研究者以标准化方式分析患者的病历以确定临床诊断。以临床结局为参考，使用ROC曲线分析评估PMPGA和SRA（n = 53）的性能。
结果
在HIT阳性患者中，低UH浓度时会产生表达磷脂酰丝氨酸的PMPs，而高UH浓度时PMP比率会显著降低。以临床结局为参考，PMPGA的敏感性和特异性分别达到88.9%（95%CI：50.7 - 99.4）和100.0%（95%CI：90.0 - 100.0）。¹⁴C-SRA的敏感性和特异性分别为88.9%（95%CI：50.7 - 99.4）和95.5%（95%CI：83.3 - 99.2）。
结论
PMPGA是一种用于HIT诊断的快速且可靠的试验。PMPGA与¹⁴C-SRA的性能显示出良好的相关性，并且与临床结局的相关性最为显著。
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