Kumano Osamu, Ieko Masahiro, Naito Sumiyoshi, Yoshida Mika, Takahashi Nobuhiko, Suzuki Takeshi, Aoki Takashi
Department of Molecular Biosciences, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan; Hemostasis Product Engineering, Sysmex Corporation, Kobe, Hyogo, Japan.
Department of Internal Medicine, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan; Department of Clinical Laboratory, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan.
Thromb Res. 2014 Aug;134(2):503-9. doi: 10.1016/j.thromres.2014.05.030. Epub 2014 May 29.
Lupus anticoagulant (LA) is an antibody that interferes with one or more in vitro coagulation reactions, which are dependent on interactions with protein-phospholipid complexes. For LA diagnosis, a mixing test is considered useful for differentiating the inhibitor from a factor deficiency. However, the usefulness and the index of circulating anticoagulant (ICA) in a mixing test with activated partial thromboplastin time (APTT) has not been adequately investigated, and there is scant information regarding the effects of warfarin, heparin, and hemophilia plasma on ICA. We evaluated the usefulness of ICA by investigating the correlation of that index with international normalized ratio (INR), heparin concentration, and factor VIII activity in hemophilia patients.
We examined samples from 28 patients positive for LA, 23 receiving warfarin, 19 receiving unfractionated heparin, and 29 with hemophilia A, as well as 61 normal samples. APTT-SLA, Actin FSL, APTT-SP, and PTT-LA were used as reagents in this study.
The correlation coefficient values between ICA and INR, heparin concentration, and factor VIII activity ranged from 0.031-0.342, 0.764-0.843, and 0.564-0.754, respectively, with the 4 reagents. The ICA values for the LA-positive samples were significantly higher than for the normal, warfarin, heparin, and hemophilia samples with all APTT reagents. Samples with a high heparin concentration above approximately 0.5U/ml showed ICA values greater than 15.
ICA was able to distinguish LA-positive samples from the normal, warfarin, and hemophilia samples, but not heparin samples. ICA calculated from APTT clotting time is useful for LA diagnosis.
狼疮抗凝物（LA）是一种干扰一种或多种体外凝血反应的抗体，这些反应依赖于与蛋白质 - 磷脂复合物的相互作用。对于LA诊断，混合试验被认为有助于区分抑制剂与因子缺乏。然而，在活化部分凝血活酶时间（APTT）混合试验中循环抗凝物（ICA）的实用性和指标尚未得到充分研究，关于华法林、肝素和血友病血浆对ICA的影响的信息也很少。我们通过研究该指标与国际标准化比值（INR）、肝素浓度以及血友病患者因子VIII活性的相关性来评估ICA的实用性。
我们检测了28例LA阳性患者、23例接受华法林治疗患者、19例接受普通肝素治疗患者、29例甲型血友病患者的样本以及61例正常样本。本研究使用APTT - SLA、Actin FSL、APTT - SP和PTT - LA作为试剂。
使用这4种试剂时，ICA与INR、肝素浓度和因子VIII活性之间的相关系数值分别为0.031 - 0.342、0.764 - 0.843和0.564 - 0.754。所有APTT试剂检测的LA阳性样本的ICA值均显著高于正常、华法林、肝素和血友病样本。肝素浓度高于约0.5U/ml的样本显示ICA值大于15。
ICA能够区分LA阳性样本与正常、华法林和血友病样本，但不能区分肝素样本。根据APTT凝血时间计算的ICA对LA诊断有用。
